Cryoglobulinemia and double-filtration plasmapheresis: Personal experience and literature review

Ther Apher Dial. 2023 Feb;27(1):159-169. doi: 10.1111/1744-9987.13885. Epub 2022 May 28.

Abstract

Background: Cryoglobulinemia is defined as the presence of an abnormal immunoglobulin that may be responsible for vasculitis of small-caliber vessels. Apheresis can be used in order to temporarily eliminate circulating cryoglobulins. The aim of this study was to assess the effectiveness of apheresis (double-filtration plasmapheresis-DFPP-) in symptomatic and/or severe cryoglobulinemias.

Methods: Four male patients presenting cryoglobulinemic vasculitis and who received DFPP sessions were included.

Results: Their mean age was 57 ± 15 years. One patient had hepatitis-C virus (HCV)-related cryoglobulinemia and the other three patients were carriers of an IgM Kappa monoclonal gammopathy. Mean duration of follow-up was 15 ± 2 months. DFPP allowed healing of ulcerative skin lesions in the first patient and remission of nephrotic syndrome in the other patients after a median of 6(5-10) sessions.

Conclusion: DFPP can be used safely in cryoglobulinemic-vasculitis and can be considered early to achieve a faster and sustained clinical-biological response.

Keywords: Waldenström disease; chronic hepatitis C; cryoglobulinemia; double-filtration plasmapheresis; membranoproliferative glomerulonephritis; rituximab.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Blood Component Removal*
  • Cryoglobulinemia* / therapy
  • Hepacivirus
  • Humans
  • Male
  • Middle Aged
  • Plasmapheresis
  • Vasculitis* / therapy