Perioperative Therapeutic Plasmapheresis

Youngblood, Sloan C.; Deng, Yi; Chen, Alice; Collard, Charles D.

doi:10.1097/aln.0b013e3182835192

Cited by 10 publications

(11 citation statements)

References 49 publications

(48 reference statements)

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“…The authors have seen a patient with bilateral pneumothorax which occurred after a central line placement in a patient with history of thymectomy [ 193 ]. Other possible complications of PLEX include citrate reaction due to hypocalcemia, which can cause perioral and limb paresthesia, nausea, vomiting, and rarely tetany, seizures and hypotension, fever, coagulopathy, and allergic reactions [ 194 ]. Citrate toxicity can be prevented by adding of 0.5 g of 10% calcium gluconate to the albumin-containing replacement fluid [ 191 ].…”

Section: Treatments Used In Severe Mg Exacerbation or Crisismentioning

confidence: 99%

Current Treatment of Myasthenia Gravis

Alhaidar

Abumurad

Soliven

et al. 2022

JCM

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Myasthenia gravis (MG) is the most extensively studied antibody-mediated disease in humans. Substantial progress has been made in the treatment of MG in the last century, resulting in a change of its natural course from a disease with poor prognosis with a high mortality rate in the early 20th century to a treatable condition with a large proportion of patients attaining very good disease control. This review summarizes the current treatment options for MG, including non-immunosuppressive and immunosuppressive treatments, as well as thymectomy and targeted immunomodulatory drugs.

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Section: Treatments Used In Severe Mg Exacerbation or Crisismentioning

confidence: 99%

Current Treatment of Myasthenia Gravis

Alhaidar

Abumurad

Soliven

et al. 2022

JCM

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“…If surgery is urgent, physicians can consider plasmapheresis or plasma exchange to reduce antibody titers prior to CPB. 18 Although a relatively new approach, intraoperative plasmapheresis has been reported to significantly reduce antibody titers, allowing heparin administration for CPB without the subsequent development of acute HIT. 19…”

Section: Cardiopulmonary Bypass In a Patient With Heparin-induced Thrmentioning

confidence: 99%

Cardiopulmonary Bypass Without Heparin

Rehfeldt

Barbara

2016

Semin Cardiothorac Vasc Anesth

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Due to familiarity, short half-life, ease of monitoring, and the availability of a reversal agent, heparin remains the anticoagulant of choice for cardiac operations requiring cardiopulmonary bypass (CPB). However, occasionally patients require CPB but should not receive heparin, most often because of acute or subacute heparin-induced thrombocytopenia (HIT). In these cases, if it is not feasible to wait for the disappearance of HIT antibodies, an alternative anticoagulant must be selected. A number of non-heparin anticoagulant options have been explored. However, current recommendations suggest the use of a direct thrombin inhibitor such as bivalirudin. This review describes the use of heparin alternatives for the conduct of CPB with a focus on the direct thrombin inhibitors.

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“…However, replacement fluids lack clotting factors and this could result in coagulopathy because of clotting factor depletion. Administration of fresh frozen plasma (FFP) eliminates this problem and is usually the preferred means of fluid replacement in the perioperative setting . TPE should be distinguished from plasmapheresis that removes a smaller amount of plasma (less than 15% of the patient's blood volume) and does not require replacement fluid.…”

Section: Introductionmentioning

confidence: 99%

“…Administration of fresh frozen plasma (FFP) eliminates this problem and is usually the preferred means of fluid replacement in the perioperative setting. 2,3 TPE should be distinguished from plasmapheresis that removes a smaller amount of plasma (less than 15% of the patient's blood volume) and does not require replacement fluid. However, this modality is used mainly for plasma donation and not for therapeutic indications.…”

Section: Introductionmentioning

confidence: 99%

Literature review of apheresis procedures performed perioperatively in cardiac surgery for ASFA category indications

Kanellopoulou

Kostelidou

2018

J of Clinical Apheresis

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Background Perioperative therapeutic plasma exchange in patients with cardiovascular diseases poses several challenges, including alterations in intravascular volume, serum electrolytes, the coagulation cascade, and drug pharmacokinetics. Methods This review article summarizes different indications of plasma exchange for patients requiring cardiac surgery based on reported case reports and case series. Results The most common reported indication is plasma exchange for the management of allosensitized cardiac transplant candidate patients in combination with immunosuppressive regimens, which increases the likelihood of obtaining a cross‐match‐negative allograft, improving post‐transplant clinical outcome. The second most common indication is for patients with a history of heparin‐induced thrombocytopenia syndrome that permits the use of heparin in cardiopulmonary bypass in an urgent cardiac surgery. Less common indications are restoration of clotting factors for patients with congenital bleeding disorders or removal of cold agglutinins. No severe complications were described in reported cases. Conclusion Therapeutic plasma exchange is an effective and safe procedure that could be performed preoperatively and intraoperatively in urgent cardiac surgery for the management of antibody‐mediated disorders including allosensitized cardiac transplant candidate patients or patients with heparin‐induced thrombocytopenia syndrome.

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Perioperative Therapeutic Plasmapheresis

Cited by 10 publications

References 49 publications

Current Treatment of Myasthenia Gravis

Current Treatment of Myasthenia Gravis

Cardiopulmonary Bypass Without Heparin

Literature review of apheresis procedures performed perioperatively in cardiac surgery for ASFA category indications

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