Auto-Immune Neuropathy Question

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im a little sketchy on a call that happened today. the call was for a patient who had a possible blood clot in her arm. I go in and uppon assesment the patient states she has "auto-immune neuropathy" in the feet and had a surgically implanted fistula into her left arm so that she could go in for "plasma diaphoresis" once a week, as that apparently assists in pain management. the patient was unable to tell me what all this meant, and neither was my partner.

everything in quotes is the patients words not mine. my question is- what the hell is plasma diaphoresis? does she mean plasma dialysis? in any case, how does this help with neuropathy?
 
You can filter neutrophils and some other immune components (like plasma cells) with dialysis.
 
Gotta love patients. 99% chance she was talking about plasmapheresis and just got the word wrong.
 
The antibodies are in the plasma cells, so you both said the same thing.
 
Aidey said:
Gotta love patients. 99% chance she was talking about plasmapheresis and just got the word wrong.
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+1, sounds like plasmapheresis

As far as I know it is pretty rare for a patient to get an AV fistula solely for plasmapheresis. Treatments are usually every 6 months but can be as frequent as monthly depending on the underlying diseases process unlike dialysis which is multiple days per week. It can usually be accomplished with a 14-16ga in the AC or subclavian CVC.

Chances are they had a coexisting disease or were getting very frequent treatments.
 
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Aidey said:
The antibodies are in the plasma cells, so you both said the same thing.
Click to expand...

I guess, but I can't actually find anything to support that you can dialyze out plasma cells. And I've never seen dialysis used to treat an autoimmune condition that had decompensated to the point of needing intervention beyond immune modulators (Myesthenia is probably the one we see most commonly).

Here is an abstract to a review about removing plasma cells, is the most recent item I can find in dealing with removing plasma cells specifically.
 
Chase said:
+1, sounds like plasmapheresis

As far as I know it is pretty rare for a patient to get an AV fistula solely for plasmapheresis. Treatments are usually every 6 months but can be as frequent as monthly depending on the underlying diseases process unlike dialysis which is multiple days per week. It can usually be accomplished with a 14-16ga in the AC or subclavian CVC.

Chances are they had a coexisting disease or were getting very frequent treatments.
Click to expand...

The pt could have Goodpasture's, and they put in the fistula in anticipation of eventual kidney failure, and are using it for the plasmapheresis in the mean time.

Dwindlin said:
I guess, but I can't actually find anything to support that you can dialyze out plasma cells. And I've never seen dialysis used to treat an autoimmune condition that had decompensated to the point of needing intervention beyond immune modulators (Myesthenia is probably the one we see most commonly).

Here is an abstract to a review about removing plasma cells, is the most recent item I can find in dealing with removing plasma cells specifically.
Click to expand...

Wiki link, under "As Therapy", 3rd item down. Plasmapheresis can be accomplished with normal dialsysis equipment.
 
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Dwindlin said:
I would think it's more likely she is having plasmapheresis to remove offending antibodies.
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For certain.

I guess I could have put more effort into forming a more accurate response.

One of my multitasking fails I guess.
 
Dwindlin said:
I guess, but I can't actually find anything to support that you can dialyze out plasma cells. And I've never seen dialysis used to treat an autoimmune condition that had decompensated to the point of needing intervention beyond immune modulators (Myesthenia is probably the one we see most commonly).

Here is an abstract to a review about removing plasma cells, is the most recent item I can find in dealing with removing plasma cells specifically.
Click to expand...

Miller's Anesthesia has a very good summary of various hemofiltration strategies.

But basically you can tailor different filters with different effects.
 
I'm currently employed at metabolic ICU and we do plasmapheresis almost daily; we've got several (young) regular patients with myasthenia gravis, guillain–barré, people after kidney translpantations and several other autoimmune diseases... plasmapheresis helps them filtrate antibodies out of their system, the procedure basically separates the plasma (and the antibodies bounded to it) and we "replace" it either with frozen human plasma or flexbumin
the treatments are usually every 2-3 weeks, occasionally (when the resuslts are bad) they have series of 5 plasmapheresis in a week... so AVF is necessary (CVC usually stays 4-6 weeks tops)
 
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