By studying the clearance of autologous labeled antibody-coated or heat-damaged erythrocytes, we showed that reversible blockade of the splenic component of reticuloendothelial function existed in 14 of 15 patients referred for treatment of nephritis or vasculitis. In 10 patients treated by plasma exchange — alone in three and combined with steroids and cytotoxic drugs in six — reversal of splenic blockade followed in nine, and in the three patients treated solely by plasma exchange this reversal was demonstrated to occur within 48 hours of the procedure. Only gradual reversal of splenic blockade was found in three of five patients treated by steroids with or without cytotoxic drugs; no change in splenic function was observed in two. When circulating immune complexes were detected by a C1q-binding assay, there was, in serial studies, an approximate inverse correlation between splenic function and the level of C1q-binding material, though hyposplenism was also a feature of patients in whom the C1q-binding assay was negative. (N Engl J Med 300:524–530, 1979) OUR studies of patients undergoing plasma exchange for immune-complex disease have highlighted the need to define the kinetics of distribution and disposal of circulating immune complexes.1,2 We have noted that in some patients plasma exchange seemed to produce beneficial effects lasting longer than would be expected from the simple physical removal of complexes from the circulation. Others have found that small-volume plasmapheresis — as little as 1 to 1.5 liters two to three times a week — had apparent clinical benefit, and suggested that high levels of complexes had caused blockade of the reticuloendothelial system and that a temporary reduction. © 1979, Massachusetts Medical Society. All rights reserved.
