Immunoadsorption Therapy Effective in E. coli-Induced HUS

Immunoadsorption effective, safe for neurological complications of hemolytic uremic syndrome

TUESDAY, Sept. 6 (HealthDay News) -- Immunoadsorption of immunoglobulin G (IgG) antibodies can safely be used to treat neurological complications in patients with Escherichia coli (E. coli) O104:H4-induced hemolytic uremic syndrome (HUS), according to a study published online Sept. 5 in The Lancet.

Andreas Greinacher, M.D., from the Institut für Immunologie und Transfusionmedizin in Greifswald, Germany, and colleagues investigated the use of immunoadsorption for the treatment of post-enteritis HUS and thrombotic microangiopathy in 12 patients with severe neurological symptoms and recently confirmed E. coli O104:H4 infection. IgG immunoadsorption processing of 12 L plasma volumes was performed on two consecutive days followed by 0.5 g/kg intravenous IgG replacement. Composite neurological symptom score was calculated daily and changes before and after immunoadsorption were evaluated.

The investigators found that renal replacement therapy was required by 10 of the 12 patients in a median of eight days. Neurological complications were observed at a median of eight days, and necessitated mechanical ventilation in nine patients. The composite neurological symptom scores improved significantly, from 3.0 in the three days before immunoadsorption to 1.0 three days afterward. Improvement was observed (disappearance of aphasia) in non-intubated patients during immunoadsorption. Among the nine patients who were intubated, five were weaned within 48 hours, two within four days, and two continued ventilation for respiratory problems. All 12 patients survived and 10 experienced complete neurological and renal function recovery.

"Our study is the first to show effectiveness of immunoadsorption for treatment of severe neurological complications related to E. coli 0104:H4 hemolytic uremic syndrome," the authors write.

Two authors disclosed financial ties to Fresenius Medical Care.

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