Effects of replacement fluids used for therapeutic plasma exchange on plasma viscosity and plasma oncotic pressure

Tek, Ibrahim; Arslan, Önder; Arat, Mutlu; Ayyildiz, Erol; Tol, Meltem; Oral, Mehmet; İlhan, Osman

doi:10.1016/j.transci.2004.02.010

Cited by 8 publications

(15 citation statements)

References 5 publications

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“…Although time-consuming and not evidence-based, fresh frozen plasma is generally preferred over albumin as replacement fluid for TPE immediately before kidney transplantation. Hemorheologic changes after TPE do not differ between both replacement strategies, but in contrast to albumin, plasma replacement avoids depletion of coagulation factors and should therefore minimize the risk of perioperative bleeding [ 16 , 17 ]. We herein aimed to provide evidence in this regard and estimated the bleeding risk after a TPE using standard coagulation parameters as well as ROTEM POC analysis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

et al. 2015

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BackgroundTherapeutic plasma exchange (TPE)-based protocols immediately before cadaveric donor kidney transplantation have been extensively used in highly sensitized recipients. Plasma is generally preferred over human albumin as replacement fluid to avoid depletion of coagulation factors and perioperative bleeding. The aim of this study was to estimate bleeding risk after TPE replaced with albumin using rotational thromboelastography (ROTEM).MethodologyTen patients without overt coagulation abnormalities underwent TPE. Standard laboratory coagulation tests (thromboplastin time, activated partial thromboplastin time (aPTT), international normalized ratio (INR), thrombin clotting time, fibrinogen levels and antithrombin activity) were compared with thrombelastometry analysis (EXTEM and INTEM tests) before and after TPE.Principal FindingsTPE significantly reduced fibrinogen levels (482 ± 182 vs. 223 ± 122 mg/dL), antithrombin activity (103 ± 11 vs. 54 ± 11 %), and prolonged aPTT (28 ± 3 vs. 45 ± 8 s), thromboplastin time (108 ± 11 vs. 68 ± 11 %), INR (0.95 ± 0.06 vs. 1.25 ± 0.16), and thrombin clotting time (18 ± 2 vs. 20 ± 3 s). INTEM and EXTEM analyses revealed significantly prolonged clot-formation time and reduced maximum clot firmness.Conclusions/SignificanceTPE replaced with albumin induces significant changes in global hemostasis parameters thus potentially increasing bleeding risk. Therefore, pretransplant TPE should be considered carefully in indicated patients before kidney transplantation. The role of the ROTEM point-of-care test to estimate the risk of bleeding in renal transplantation needs to be evaluated in further studies.

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Section: Discussionmentioning

confidence: 99%

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

et al. 2015

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“…Forty‐two included studies fulfilled our predefined criteria. Thirty‐seven were RCTs, 13‐49 and five were prospective cohort studies 7,50‐53 . An overview of included studies can be seen in (Table S1).…”

Section: Resultsmentioning

confidence: 99%

“…Clinical conditions for the use of TPE included: neurological (18/42, 43%), 13‐30 immunological (9/42, 21%), 31‐39 renal (4/42, 10%), 40,41,50,51 rheumatology (2/42, 5%), 42,43 hematological (2/42, 5%), 44,52 dermatological (1/42, 2%), 45 and other categories (6/42, 14%) 7,46‐49,53 . The most common type of replacement fluids used were albumin (30/42, 71%), 7,13‐17,19,20,24‐27,29‐38,41,42,45‐48,50,51 albumin mix with other fluids (9/42, 21%), 7,18,21,23,39,44,46‐48 and FFP (4/42, 10%) 21,46,49,53 . Six studies (14%) 7,21,38,46‐48 used more than one replacement fluid.…”

Section: Resultsmentioning

confidence: 99%

“…Where stated, patients in 69% (29/42) 7,[13][14][15][16]18,19,21,23,24,[26][27][28]30,32,[35][36][37][38][39][41][42][43][44][45][46][47][48]51 of the studies were older than 16 years. Follow up duration varied in length with a median follow up of 6 months (IQR 1-13).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The main factors for choosing a replacement fluid during TPE are dependent on availability of the fluid type and its cost, patient's baseline bleeding risk, and the underlying disease condition 7 . For example, FFP is the preferred fluid for TPE in patients who are at risk of bleeding, who have thrombotic TTP, or who are due to undergo major surgeries where bleeding risk could be high (eg, renal transplantation) 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used

Kohli

Geneen

Brunskill

et al. 2022

J of Clinical Apheresis

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ObjectiveThe aim of this systematic scoping review is to identify and categorize the outcome measures that have been reported in clinical studies, where therapeutic plasma exchange (TPE) has been used as an intervention in any clinical settings, excluding thrombotic thrombocytopenic purpura (TTP).MethodsWe searched electronic databases using a predefined search strategy from inception to October 9, 2020. Two reviewers independently screened and extracted data.ResultsWe included 42 studies (37 RCTs and 5 prospective cohort studies) grouped into six main categories (neurology, immunology, renal, rheumatology, hematology, and dermatology). Primary outcomes were defined in eight studies (19%, 8/42) and were categorized as efficacy (five studies) or patient reported outcomes (three studies). A power calculation was reported in six studies (75%, 6/8): five neurology studies (mainly patient reported outcomes) and a single immunological study (efficacy outcome). Disease‐specific efficacy outcomes were dependent on the clinical setting of the population receiving TPE. Most of the trials (43%, 18/42) were undertaken in patients with neurology conditions where clear, disease‐specific, clinical outcome measures were used, including neurological disability scales (11/18, 61%), change in neurological examination (9/18, 50%), and functional improvement scores (7/18, 39%). For other conditions, the reporting of disease‐specific outcomes was poorly reported. Safety outcomes were mainly related to replacement fluid type rather than being disease‐specific. The most common outcome reported was hypotension (19%, 8/42), and this was primarily in patients exchanged with albumin.ConclusionFuture clinical studies to determine which fluid replacement option is most efficacious and safe should use disease‐specific outcomes, as a trial in one therapeutic area may not necessarily translate to another therapeutic area. Patient reported outcomes are not universally reported for all disease areas. Safety measures focused primarily on fluid safety.

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Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study

Kohli

Allen

Platton

et al. 2022

J of Clinical Apheresis

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Introduction: Therapeutic plasma exchange (TPE) is used for several chronic conditions with little evidence on the efficacy and safety of different choice of replacement fluid. Measurement of haemostasis, particularly in vitro thrombin generation, could play a role in determining the immediate efficacy of different fluid replacement. Aim: To determine the impact of different TPE replacement fluid regimens on haemostatic assays. Methods: Prospective observational multi-centre cohort study in adult patients 18 years and older evaluating haemostatic changes between four different TPE regimens: (1) 5% human albumin solution (Alb) only, (2) 50:50 mix of 5% Alb + modified gelatin, (3) 70:30 mix of 5% Alb and normal saline (NS), and (4) solvent-detergent, virus-inactivated fresh frozen plasma (FFP) (either alone or combined with other fluids). Twenty-one haemostasis variables were analysed (procoagulant, anticoagulant and fibrinolytic factors) pre and post TPE sessions, including in vitro thrombin generation. Linear mixed modelling and canonical discriminant analyses were used to examine the effect of TPE fluid type on haemostatic variables.Results: A total of 31 patients with up to 5 TPE sessions each (131 sessions in total) were enrolled. Out of 21 markers analysed using linear mixed modelling, the main effects of fluid type were found to be significant for 19 markers (P < 0.05), excluding plasminogen activator inhibitor-1 antigen and thrombinanti-thrombin. Multivariate Analysis of Variance showed significant differences between the fluid types (Wilks' lambda = 0.07; F 63,245.61 = 5.50; P < 0.0001) and this was supported by a canonical discriminant analysis, which identified the 4 most discriminating markers for fluid types as thrombin generation (lag-time, time-to Peak), fibrinogen and Factor V. In our analyses, the effect of FFP on haemostasis was significantly greater compared with other

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Effects of replacement fluids used for therapeutic plasma exchange on plasma viscosity and plasma oncotic pressure

Cited by 8 publications

References 5 publications

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM)

Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used

Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study

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