Effect of double filtration plasmapheresis on various plasma components and patient safety: A prospective observational cohort study

Abstract

Double filtration plasmapheresis (DFPP) was historically used for blood group incompatible renal transplantation. Very few studies are available worldwide regarding its efficiency in removing specific plasma components, and safety. We conducted a prospective observational cohort study over 1 year on patients undergoing DFPP for various renal indications. There were 15 patients with 39 sessions. The pre- and post-procedure plasma samples of serum IgG, IgA, IgM, fibrinogen, calcium, phosphate, potassium, and magnesium were analyzed. The effluent albumin concentration was also measured, and complications during the hospital stay were recorded. Cumulative removal of serum IgG, IgA, IgM, fibrinogen, and albumin at the end of four sessions were 72%, 89%, 96%, 88.5%, and 21.3%, respectively and effluent albumin concentration was 1.75 – 2.0 times (range: 6.3 g/dl – 7.2 g/dl; mean ± standard deviation (SD) – 7 g/dl ± 0.3 g/dl) the preprocedural serum albumin (mean ± SD – 3.5 g/dl ± 0.5 g/dl). Removal of other plasma components were not statistically significant. Hypotensive episodes were observed only 16.6%, with the usage of effluent concentration albumin as replacement fluid despite an average 2.4 (mean ± SD – 2.4 ± 0.4 l) liters of plasma volume processing each session. DFPP removes IgG, IgA, IgM, fibrinogen, and albumin. The cumulative removal IgG (72%) is suboptimal, whereas IgA (89%) and IgM (96%) are comparable to historical controls. We observed lesser episodes (12.5%) of hypotension with effluent albumin concentration as replacement fluid, and all bleeding complications were observed when serum fibrinogen level was <50 mg/dl.

Double filtration plasmapheresis in treatment of acute pancreatitis associated with severe hypertriglyceridemia

“…Human albumin can be used as the alternative replacement fluid, but it is much more expensive relative to plasma. [ 13 ] Thus, we are interested to explore the therapeutic potential of DFPP on HTG-AP and further scrutinize the patients’ outcome.…”

A rare occurrence of anti-glomerular basement membrane glomerulonephritis complicated by heparin-induced thrombocytopenia

“…This activates the coagulation cascade and also leads to platelet activation. As a result, anticoagulation is often used to maintain blood flow and allow effective treatment [6].…”

Potential of therapeutic plasmapheresis in treatment of COVID-19 patients: Immunopathogenesis and coagulopathy

“…In this regard, there is a report of double filtration plasmapheresis (DFPP) to reduce viral RNA for the hepatitis C virus (HCV) with the reason that HCV particles are large enough (approximate diameter 55-60 nm) to not pass through the membrane so they can be eliminated [ 2 ]. Considering the size of the SARS-CoV2(60-140 nm), the use of DFFP seems to be effective in reducing the virus load due to its ability to remove particles larger than 60 nm [ [31] , [32] , [33] ].…”