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2nd Congress of the European Group – International Society for Apheresis

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03/23/2018 - Foyer | 1:45pm - 3:15pm 
Poster session 3 (P-23–P-32): Miscellaneous 2

Chairs: U. Julius (Dresden, Germany), H. Sinzinger (Vienna, Austria)

P-23 This poster has been withdrawn.
Abstract text :

P-24 This poster has been withdrawn.
Abstract text :

P-25 Rheopheresis in diabetic foot ulceration– Results of 3 years follow-up
*Ágnes Diószegi1, Melinda Nánásy-Vass1, Norbert Németh1, Miklós Káplár1, Katalin Veres1, Pál Soltész1
1 University of Debrecen, Clinical Center, Department of Internal Medicine, Debrecen, Hungary
Abstract text :

Question: Diabetic foot disease is a late and severe complication of diabetes mellitus. More than 60% of non-traumatic amputations in the western world are performed in the diabetic people. Beside the standardized conservative treatment, new therapeutic approaches are needed to lowering amputation incidence.

Methods and patient: Rheopheresis is a double cascade filtration system. The separated plasma is passing a secondary filter, the rheofilter.  We used Art Universal machine with MONET filter developed by Fresenius Medical Care. The MONET filter retains high molecular weight proteins such as cholesterine, triglyceride, LDL, Lp (a), fibrinogen, α2 macroglobulin and vWF. Two diabetic patients with severe foot ulcers were treated by MONET treatment from 2014 December. The first patient had non-healing foot ulcers caused by severe ischemia and polyneuropathy on the lower extremity. The wounds were classified by Wagner criteria. Before rheopheresis there was a localized gangreane on the feet (baseline Wagner 4), and a deep, phlegmonosus ulcer on the leg (baseline Wagner 2). Two treatments were performed in one session in 2014. The other patients had neuropathic ulceration on his right sole. Altogether 4 treatments were done in two sessions between 2015-2016. To evaluate effectiveness of MONET treatment laboratory parameters of blood rheology, endothelial and platelet activation, and lipid levels were measured. Transcutaneous oxygen pressure (tcPO2), photo documentation of wound healing was also repeatedly performed.

Results: Rheopheresis improved microcirculation by normalised plasma and whole blood viscosity, significantly decreased atherogenic lipid fractions, P-selectine and vWF level. In 3 years1(2014-2017) follow up wound healing accelerated, and after 18 month complete wound healing was achieved in the first patient, while in the other patient the wound size significantly diminished. Major amputation or hospitalization could be avoided in our patients.

Conclusions: Our results show that rheopheresis can be a new therapeutical option in diabetic foot disease to reserve a functional lower extremity.

P-26 Data from the WAA register – Up date of patients 21 years and older.
*Bernd Stegmayr1, E. Newman2, V. Witt3, K. Derfler3, G. Leitner3, S. Eloot4, A. Dhohnt4, D. Deeren5, J. Ptak6, M. Blaha7, M. Lanska7, Z. Gasova8, Z. Bhuiyan-Ludvikova8, R. Hrdlickova9, W. Ramlow10, H. Prophet10, G. Liumbruno11, E. Mori12, A. Griskevicius13, J. Audzijoniene13, H. Vrielink14, E. Reuser Kaasenbrood15, A. Aandahl16, A. Sikole17, J. Tomaz18, I. Bojanic19, S. Ortega Sanchez20, V. Strineholm21, B. Brink22, G. Berlin23, I. Landerstam24, F. Toss25, M. Mörtzell Henriksson25, T. Nilsson26, K. Mokvist26, F. Knutson26, J. Dykes24, B. Ramsauer27, A. Wahlström28
1 Umea University, Sweden, Public Health and Clinical Medicine, Umea, Sweden
2 WAA Registry Study Group, , New South Wales, Australia
3 WAA Registry Study Group, , Vienna, Austria
4 WAA Registry Study Group, , Gent, Belgium
5 WAA Registry Study Group, , Roeselar, Belgium
6 WAA Registry Study Group, , Frydek-Mistek, Czech Republic
7 WAA Registry Study Group, , Hradec Kralove, Czech Republic
8 WAA Registry Study Group, , Prague, Czech Republic
9 WAA Registry Study Group, , Ostrava, Czech Republic
10 WAA Registry Study Group, , Rostock, Germany
11 WAA Registry Study Group, , Rome, Italy
12 WAA Registry Study Group, , Livorno, Italy
13 WAA Registry Study Group, , Vilnius, Lithuania
14 WAA Registry Study Group, , Amsterdam, Netherlands
15 WAA Registry Study Group, , Maastricht, Netherlands
16 WAA Registry Study Group, , Oslo, Norway
17 WAA Registry Study Group, , Skopje, Republic of Macedonia
18 WAA Registry Study Group, , Coimbra, Portugal
19 WAA Registry Study Group, , Zagreb, Croatia
20 WAA Registry Study Group, , Barcelona, Spain
21 WAA Registry Study Group, , Orebro, Sweden
22 WAA Registry Study Group, , Huddinge, Sweden
23 WAA Registry Study Group, , Linköping, Sweden
24 WAA Registry Study Group, , Lund, Sweden
25 WAA Registry Study Group, , Umea, Sweden
26 WAA Registry Study Group, , Uppsala, Sweden
27 WAA Registry Study Group, , Skövde, Sweden
28 WAA Registry Study Group, , Karlstad, Sweden
Abstract text :

The electronic registration through a web-page has been possible, at no cost, since 2002. So far 36 centres from 17 countries have entered data.  A total of 87147 procedures (12853 patients) have been reported up to January 18, 2018. Data was missing of the age of the patients in 159 procedures (46 patients). A total of 12048 patients (94%) were in the range 21-94 years. They had performed 82354 procedures, respectively. Most patients were treated with stem cell collection (42%) adding collection from donors (9.7%), plasma exchange by centrifugation (30%) or filtration (2%), photopheresis (2.7%), lipid apheresis in 179 patients.

The extent of work-load in the units for these children was most pronounced for centrifugation (35%), lipid apheresis (27%), cell collection (13%), and photopheresis (11%). Documented was that one patient with plasmacell leukemia died by myocardial infarction during the apheresis, an plasma reaction was present in parallel, thus it is unclear if the apheresis contributed or not. Side effects appeared as mild (in 2.4%), moderate (3.3%) or severe (0.3%) of the procedures.  The most common diagnoses treated were mainly oncological diseases and haematological

The distribution of the treatments over the years will be reported.

Conclusion: Approximately 94% of apheresis is performed on adults. Although most patients suffer from malignant diseases.

P-27 Iron deficiency in patients undergoing immunoadsorption
*Katharina Artinger1, Tobias  Niedrist2, Andreas Meinitzer2, Alexander R. Rosenkranz1, Kathrin Eller1
1 Clinical Division of Nephrology, Department of Internal Medicine Graz, Graz, Austria
2 Clinical Institute of Medical and Chemical Laboratory Diagnostics, , Graz, Austria
Abstract text :

Introduction/Research Questions: Immunoadsorption is a well-established tool for the treatment of a variety of antibody –mediated diseases where conventional therapy has reached its limits. Anemia has a prevalence of 32.9% globally with the most common cause being iron deficiency. In lipoprotein apheresis, iron deficiency is a common finding. However, direct evidence of iron loss through apheresis is lacking so far. We observed anemia and low iron status in patients undergoing immunoadsorption. The aim of this ongoing prospective observational study is to evaluate the potential role of immunoadsorption on the development of iron deficiency due to loss of iron through binding and removal on immunoadsorption columns during apheresis.

Methods: Patients undergoing immunoadsorption before AB0-incompatible kidney transplantation are prospectively included in this study. Iron status, Vitamin B12, folic acid and red blood cell count are measured before initiation of the first immunoadsorption as well as before and after each following immunoadsorption with AB0 columns and a continuous-flow centrifugation system. Eluate containing adsorbed substances are evaluated for the abundance of iron. All measurements are performed on a COBAS 8000 c502.

Results: We have results from one male patient so far. His serum-iron decreased from 65 µg/dl to 50 µg/dl after the first, and to 42 µg/dl after the second immunoadsorption, which was performed two days after initiation. Serum-Vitamin B12 decreased from 609 pg/ml to 495 pg/ml after the first, and to 361 pg/ml after the second immunoadsorption. Serum-folic acid decreased from 7,7 ng/ml to 2,3 ng/ml and 2,8 ng/ml after the first and second immunoadsorption, respectively. In the eluate, 28 µg/dl iron was detected. Notably, iron was also detected in the eluate of a patient treated with Ig apheresis.

Conclusion: Our preliminary findings suggest an effect of immunoadsorption on the development of iron deficiency due to adsorption of iron via the AB0 column, however the number of patients and follow up time need to be increased for further evaluation.

P-28 Dynamics of proprotein convertase subtilisin kexin 9 (PCSK9) in the treatment with rheopheresis in age related macular degeneration
Milan Blaha1, Hana  Langrova2, Vladimir Blaha3, *Miriam Lanska1, Jan Studnicka2, Alexander Stepanov2
1 Medical Faculty and Teaching Hospital, 4th Dpt. of Medicine, Haematology, Hradec Kralove, Czech Republic
2 Medical Faculty and Teaching Hospital, Dpt. of Ophthalmology, Hradec Kralove, Czech Republic
3 Medical Faculty and Teaching Hospital, 3rd Dpt. of medicine, Gerontology and Metabolism, Hradec Kralove, Czech Republic
Abstract text :

Aim: The circulating liver-derived protein, proprotein convertase subtilisin/kexin type-9 (PCSK9), has emerged in the last decade as a major drug target in cardiovascular medicine. Hypotheses on the causes of age-related macular degeneration (AMD) indicate a possible role of lipoproteins. The aim of our study was to examine the dynamics of PCSK9 during therapy of AMD with rheopheresis

Methods and group of patients: 19 patients with dry form of AMD (9 females and 10 males, age 77.8±4.3, median 69) were treated with rheopheresis - 8 procedures for 10 weeks. We used extracorporeal plasma filtration: plasma separation using blood cell separators Cobe Spectra or Optima (Terumo, USA) plus filtration - Evaflux 4A filter (Kawasumi, Japan). Reduction of blood viscosity increases the flow in the microcirculation and support of the recovery processes in the retina. The PCSK9 level was examined (Quantikine ELISA PCSK9 kit). The control group included blood donors (54 healthy individuals, 28 males, 26 females, age 54.9±6.7 years, median 56 years).

Results: The baseline patients' PCSK9 level was increased - median 192ng/L. Median in the controlled group was 136ng/L (p=0.02). The values are significantly reduced following the rheopheretic procedures (p<0.0001). The PCSK9 level correlates with the level of total cholesterol, it does not correlate with LDL, HDL cholesterol, fibrinogen, viscosity of plasma and blood, apolipoprotein B, IgM and alpha2-macroglobulin. The PCSK9 level is not significantly different in patients who succeeded with therapy compared to those who did not.

Conclusion:The acquired knowledge on PCSK9 dynamics in the treatment with rheopheresis verifies the theory on possible contribution of lipoprotein metabolism disorders in the development of AMD. Currently, when even the treatment with monoclonal antibodies against PCSK9 is available, they have not only theoretical but also practical clinical potential.

Acknowledgments: Supported by the grant AZV 17-29241A.

P-29 Amount of RNA contamination in samples from the rinse of the apheresis column
*Dana Dlouha1, Iveta  Prochazkova1, Milan Blaha2, Vladimir Blaha3, Ilona Fatorova2, Jaroslav Hubacek1, Jan Pitha1
1 Institute for Clinical and Experimental Medicine, Centre for Experimental Medicine, Prague, Czech Republic
2 Charles University School of Medicine and Teaching Hospital, 4th Department of Internal Medicine, Hradec Králové, Czech Republic
3 Charles University School of Medicine and Teaching Hospital, Department of Gerontology and Metabolism, Hradec Králové, Czech Republic
Abstract text :

Background: LDL- apheresis therapy is a type of "extracorporeal" procedure to remove low-density lipoprotein (LDL) cholesterol from the blood.  In our research, we target molecular markers - small noncoding RNAs in patients under long-term apheresis treatment. The aim of the current experiment was to analyze possible RNA contamination of apheresis column.

Materials and methods: We performed real-time qPCR for measurement of 19 samples from the rinse of apheresis column before procedures. As negative controls, we used 3 samples of PCR clean water included in three different RNA isolations. As positive controls, we used 3 plasma samples. We compared Ct (threshold cycle) values of three SpikeIns –used for control of RNA isolation (UniSp2, UniSp4, UniSp5) and 3 reference miRNAs – stably expressed miRNAs in plasma (hsa-miR-191-5p; hsa-miR-103-3p; hsa-let7a). Ct value is inverse to the amount of template.

Results: RNA controls and reference miRNAs were in negative controls and in 4 samples from the flushing/rinse undetectable. Ct values of SpikeIn controls in other 15 samples were significantly higher than in plasma samples (for UniSp2: 26.9 vs 19.5, for UniSp4: 33.0 vs 25.7, for UniSp5: 36.0 vs 32.1), which indicates very poor or any amount of RNA. Reference miRNAs were in all samples from the rinse undetectable.

Conclusions: Samples from the rinse of apheresis column showed an only limited amount of templates for control of RNA isolation. We detected any RNA contamination of the apheresis column.

Supported by Ministry of Health of the Czech Republic, grant nr. 17-28882A and the conceptual development of research organization ("Institute for Clinical and Experimental Medicine – IKEM, IN 00023001") All rights reserved. The poster will be presented by my colleague and the second co-author of the study: Iveta Prochazkova.

P-30 Anatomical mapping of muscle-related side-effects of statins
Theresa Berent1, Sabine Steiner2, *Robert Berent3, Helmut Sinzinger1
1 Insitut Athos, , Vienna, Austria
2 University of Leipzig, Interventional Angiology, Leipzig, Germany
3 HerzReha Bad Ischl, Center for cardiovascular rehabilitation, Bad Ischl , Austria
Abstract text :

Introduction: Statins are potent inhibitors of cholesterol biosynthesis and are an established therapy for primary and secondary prevention of cardiovascular diseases. Muscle and skeletal-related symptoms are the most common adverse effects associated with statin use. Creatine kinase (CK) elevation may be present, rhabdomyolysis is a rare event. In this retrospective analysis we characterized localization, clinical symptoms, time of appearence and influencing facts inducing muscle-related side-effects.

Methods: 1111 consecutively admitted patients (537 female, 574 male, age of 11-86 year) on statin monotherapy with side effects were included during a 4-year period. Anatomical mapping of the affected muscles, signs and symptoms, the onset of symptoms after starting statin therapy and disappearance after discontinuing treatment was assessed. Age, gender, waist circumference, alcohol consumption, concomitant medication and prescribed statins were explored.

Results: Mapping revealed that activated muscles due to exercise were affected in > 80%. In the upper extremity, myopathy was mainly described at the dominating side, in the lower extremity in the contralateral one. Symptoms were most often related to the pectoral muscle (61,4%), the quadriceps femoris (59,8%), the biceps brachii (54,3%) and the deltoid muscle (22,5%). Cramps were reported in 41,9% and were mainly experienced in isolated muscle groups the day after physical activity. Aches appeared in 32,7%, weakness in 18,3%, stiffness in 7,1% which was more frequent in females. Stiffness and weakness appeared mostly as generalized symptoms. More than 95% of patient with myopathy had no CK elevation. Most symptoms appeared within 14 days after starting statin therapy (76,9%). Aches were described very soon after initiation (mean 3,89 days), weakness much later (mean 4 months). Symptoms disappeared after discontinuation of statin therapy at a mean of 5,4 days. No influence of age, gender, waist circumference, alcohol consumption and concomitant medication was observed. Moreover, myopathy was not influenced by kind of statin prescription.

Conclusions: Physical activity seems to be a key trigger for muscle-related side-effects. Clinical symptoms are more often seen with exercise, can be symmetrical, asymmetrical, generalized or in isolated muscle groups only mostly without CK elevation. All available statins can cause muscle-related side-effects in the same extent.

P-31 Molecular genetic diagnosis helps to predict the outcome of PCSK9 inhibitor therapy
*Mato Nagel1, Mandy Benke1, Ioan Duma1, Constantina Vlad1, Thomas Lucke1, Sylvia Nagorka1
1 Zentrum für Nephrologie und Stoffwechsel, , Weisswasser, Germany
Abstract text :

Our cohort of patients on LDL apheresis consists of 12 patients. 4 of them were on apheresis because of isolated high LDL levels. 8 patients showed high LDL along with remarkably elevated Lp(a). In all patients, PCSK9 inhibitor therapy was started. While the 8 patients with elevated Lp(a) levels respond well to the therapy with a remarkable decrease in LDL cholesterol, the Lp(a) still remains high so that LDL apheresis was continued. Among the 4 patients that showed isolated LDL elevation only one responds sufficiently to PCSK9 inhibitor therapy, so in this case LDL apheresis was discontinued and he is doing well with PCSK9 inhibitor therapy alone. Genetically this patient has a heterozygous APOB mutation that obviously could be well compensated by the PCSK9 inhibitor. The other three patients were unresponsive. Two siblings harbor the same compound heterozygous genotype of LDLR mutations and the other patient harbors a homozygous APOE mutation and a heterozygous LIPC mutation. Her LDL, though it can be removed effectively by LDL apheresis, differs biochemically, so it obviously cannot be cleared by the normal LDLR pathway.

P-32 A successful term pregnancy with severe hypertriglyceridemia and acute pancreatitis: case report and literature review.
*Seila Perrone1, Roberto  Brunelli1, Giuseppina Perrone1, Paola Galoppi1, Ilaria  Zannini1, Serafina Di Giacomo2, Claudia  Morozzi2, Claudia  Stefanutti2
1 “Sapienza” University of Rome, “Umberto I” Hospital, Department of Gynecological, Obstetrical and Urological Sciences , Rome, Italy
2 “Sapienza” University of Rome, “Umberto I” Hospital, Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohaematology and Transfusion Medicine, Department of Molecular Medicine, Rome, Italy
Abstract text :


Acute hypertriglyceridemic pancreatitis in pregnancy is a rare but life threatening condition for mother and fetus. During pregnancy significant alterations of lipid homeostasis occur to ensure transfer of nutrients to the fetus. In some women, with a genetic predisposition, elevation of serum triglycerides can lead to very serious complications like acute pancreatitis. Actually there is no guidelines for the management of this severe condition. The use of plasmapheresis has been reported in the last few years (ASFA 2013),  therefore we propose a successful management of acute hypertriglyceridemic pancreatitis in pregnancy and a review of literature.


We report a case of acute hypertriglyceridemic pancreatitis onset in the second trimester of pregnancy in a patient that stopped any medications and appropriate diet at the beginning of  pregnancy. At hospital admission, in consideration of clinical conditions and high triglycerides levels (4425 mg/dL), three therapeutic apheresis procedures (plasma exchange) was conducted with reduction of triglycerides value and clinical improvement. Oral therapy with hypolipidemic drugs was started and a continuous maternal and fetal follow up was performed during pregnancy and up to three months after delivery.


Based on our experience therapeutic apheresis  can be helpful in pregnancy because is safe for mother and fetus, can be used to overcome acute event and reach more advanced gestational age. Reported  cases show that if hypertriglyceridemic pancreatitis rises up in the first or second trimester, the pregnancy does not reach the term of pregnancy. In our case  the use of therapeutic apheresis allowed the patient to maintain adequate triglycerides levels, to decrease the risk of a new pancreatitis and to reach the term of pregnancy without complications for both mother and baby.


Specific guidelines for apheresis in pregnancy are still lacking: characteristics and timing of therapeutic approach, preferred drugs and dosage, monitoring fetal follow up schedule are still matter of discussion.