engleski

Lymphocitoplasmapheresis treatment in active ulcerative colitis-case report

The natural course of ulcerative colitis (UC) is chronic and relapsing. Long term treatment with steroids and immunosuppressive drugs is accompanied with numerous side effects. Leucocytapheresis is proved to be effective in active faze of the disease, and also in keeping remission. We present patient in active faze of UC that has been treated with lymphocyto-plasmapheresis (LCPA) for the first time in Croatia. LCPA was performed by COBE Spectra Aphaeresis System (Software Version 6.1), (Gambro BCT, Lakewood, USA) according to COBE Spectra Therapeutic Apheresis Guide. The mean lymphocytes removed per session was 2, 02 ± ; 0, 76 x 109, together with mean of 2100 ± ; 636 ml plasma. LCPA was carried out through peripheral venous accesses, without any side effects. Case report: twenty-two year old man with UC has been admitted in active faze of the disease accompanied with chronic anemia. The diagnosis was established two years ago in county hospital as pancolitis. He has been initially treated with mesalazine and steroids, but because of the steroid dependant disease and skin side effects, azatioprin in very low dosage had to be started six months after the diagnosis. For the next two years he has been hospitalized several times in clinical exacerbation, treated symptomatically and with high dose steroids. In April 07 he was admitted, for the first time, to our Department because of the severe anemia and active disease (Clinical activity index, CAI 10, high inflammatory reactants). Considering possible cyclosporine and infliximab therapy, we decided to start with LCPA, initially two times a week for two weeks, than once a week for one month and than once a month. During hospitalization we performed three LCPA, which led to significant clinical improvement without any side effects. During the treatment patient needed three erythrocyte transfusions (in total 2100 ml). He was discharged without initiating steroids, CAI 4 and normal CRP level. He continued with the procedure (so far 12 LCPA), and for the whole time he is in clinical remission, CAI 2-3, only on mesalazine and azatioprin. Activated leucocytes are formed as a result of various interactions between lymphocytes, antigens, antigen presenting cells and cytokines, and have the ability to cause and enhance inflammatory process and destroy the tissue producing proteases and oxygen radicals. LCPA is used to remove lymphocytes and inflammatory cytokines, so it has a great impact in active disease and maintaining remission. Conclusion: we presented our first UC patient that has been treated by LCPA. Our impression is that the procedure is effective, safe, and can be used as an alternative therapeutic method without significantly affecting total white blood cell count and can reduce the need for steroids in active faze of the disease. We hope to use it more often in treating active disease and also maintaining the remission, but further studies are needed to establish optimal therapy protocol.

Lymphocitoplasmapheresis; ulcerative colitis

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