Double-filtration plasmapheresis in the treatment of leg ulcers in cryoglobulinemia

Hepatitis C virus (HCV) is the major cause of cryoglobulinemia. Skin lesions are frequent and can benefit from the removal of cryoglobulins by therapeutic apheresis. We describe a case of HCV-positive type I cryoglobulinemia with severe leg ulcers, not responsive to antiviral and immunosuppressive treatment. Thirty sessions of double filtration plasmapheresis were performed, over a period of 6 months, with no other associated treatment. Before and after each session assessment was made of: immunoglobulins, complement, cryocrit, fibrinogen. HCV RNA levels were determined in serum cryoprecipitate, supernatant before and after each session and in the collection bag. No differences were observed either in the serum concentrations or the supernatant between the pre- and post-apheresis values, whereas the post-apheresis cryoprecipitate showed a significantly reduced viral load (p<0.02) as compared with the pre-apheresis values. The leg ulcers improved during apheresis and had completely regressed by the end of the cycle.