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Therapeutic plasma ...
Therapeutic plasma exchange as a novel treatment for severe intrahepatic cholestasis of pregnancy: Case series and mechanism of action
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Ovadia, C. (författare)
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- Lovgren-Sandblom, A. (författare)
- Karolinska Institutet
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Edwards, L. A. (författare)
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Langedijk, J. (författare)
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Geenes, V. (författare)
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Chambers, J. (författare)
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Cheng, F. (författare)
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Clarke, L. (författare)
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Begum, S. (författare)
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Noori, M. (författare)
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Pusey, C. (författare)
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Padmagirison, R. (författare)
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Agarwal, S. (författare)
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Peerless, J. (författare)
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Cheesman, K. (författare)
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Heneghan, M. (författare)
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Elferink, R. O. (författare)
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Patel, V. C. (författare)
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- Marschall, Hanns-Ulrich, 1954 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Williamson, C. (författare)
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(creator_code:org_t)
- 2018-10-15
- 2018
- Engelska.
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Ingår i: Journal of Clinical Apheresis. - : Wiley. - 0733-2459 .- 1098-1101. ; 33:6, s. 638-644
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Introduction Intrahepatic cholestasis of pregnancy is characterised by pruritus and elevated serum bile acids. The pruritus can be severe, and pharmacological options achieve inconsistent symptomatic improvement. Raised bile acids are linearly associated with adverse fetal outcomes, with existing management of limited benefit. We hypothesised that therapeutic plasma exchange removes pruritogens and lowers total bile acid concentrations, and improves symptoms and biochemical abnormalities in severe cases that have not responded to other treatments. Methods Four women with severe pruritus and hypercholanemia were managed with therapeutic plasma exchange. Serial blood biochemistry and visual analogue scores of itch severity were obtained. Blood and waste plasma samples were collected before and after exchange; individual bile acids and sulfated progesterone metabolites were measured with HPLC-MS, autotaxin activity and cytokine profiles with enzymatic methods. Results were analysed using segmental linear regression to describe longitudinal trends, and ratio t tests. Total bile acids and visual analogue itch scores demonstrated trends to transiently improve following plasma exchange, with temporary symptomatic benefit reported. Individual bile acids (excluding the drug ursodeoxycholic acid), and the sulfated metabolites of progesterone reduced following exchange (P = .03 and P = .04, respectively), whilst analysis of waste plasma demonstrated removal of autotaxin and cytokines. Conclusions Therapeutic plasma exchange can lower potentially harmful bile acids and improve itch, likely secondary to the demonstrated removal of pruritogens. However, the limited current experience and potential complications, along with minimal sustained symptomatic benefit, restrict its current use to women with the most severe disease for whom other treatment options have been exhausted.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Nyckelord
- autotaxin
- bile acids
- cytokine
- obstetric cholestasis
- progesterone sulfate
- pruritus
- ursodeoxycholic acid
- progesterone metabolites
- bile
- pruritus
- autotaxin
- plasmapheresis
- cytokines
- cells
- women
- trial
- Hematology
- appell lc
- 2012
- bmj-brit med j
- v344
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Ovadia, C.
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Lovgren-Sandblom ...
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Edwards, L. A.
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Langedijk, J.
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Geenes, V.
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Chambers, J.
-
visa fler...
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Cheng, F.
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Clarke, L.
-
Begum, S.
-
Noori, M.
-
Pusey, C.
-
Padmagirison, R.
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Agarwal, S.
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Peerless, J.
-
Cheesman, K.
-
Heneghan, M.
-
Elferink, R. O.
-
Patel, V. C.
-
Marschall, Hanns ...
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Williamson, C.
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Gastroenterologi
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Reproduktionsmed ...
- Artiklar i publikationen
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Journal of Clini ...
- Av lärosätet
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Göteborgs universitet
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Karolinska Institutet