Infection and pneumonia were serious complications of plasmapheresis. This risks were due in part from decrease of IgG subclasses. Thus, the measurements of IgG subclasses were made before and after plasmapheresis. An increase of IgG subclass levels was measured after treatment with 50mg/kg intravenous immunoglobulin preparation, which was given after 24 hours of plasmapheresis.
After 8 times of immunoadsorbent plasmapheresis, IgG1, 2, 4 decreased 90% and IgG3, 50% of pre-therapy. On the other hand, IgG1, 2, 3, 4 revealed a 60% reduction after 12 times of plasmapheresis, which 3 liters of plasma were replaced with 5% albumin-Hartmann solution. The level of IgG2 occasionally showed below 10mg/dl after replacement of 5% albumin-Hartamann solution.
Three different preparations of immunoglobulin (1-immunoglobulin treated with polyethylenglycol, 2-immunoglobulin treated with trace of pepsin in pH 4, and 3-immunoglobulin treated with sulfonation) were used to increase the level of IgG subclasses and their results were compared one each other. The increase of IgG 1, 2, 3, 4 was more pronounced after infusion of immunoglobulin treated polyethyleneglycol and trace of pepsin in pH 4 than infusion of immunoglobulin treated with sulfonation. However, in all conditions, after 1 week of albumin replaced plasmapheresis with infusion of immunoglobulin preparation were showed low levels of IgG subclasses.
It suggested that infusion of immunoglobulin preparation after albumin repalced plasmapheresis was necessary more than 50mg/kg dose. And, the check of IgG subclass was important after plasmaphersis.
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