Potential Danger of Thrombosis after Plasma Exchange in the Treatment of Patients with Immune Disease

Abstract

Coagulation studies were serially performed before and after repeated plasma exchange in seven patients with myashtenia gravis. The fall in platelets and coagulation factor activities after plasmapheresis using a replacement material devoid of clotting factors was not so low that bleeding episodes were to be feared and no hemorrhages were observed. In contrast, thrombotic phenomena were suspected in two patients. Antithrombin III fell to undetectable levels in some cases. This finding associated with elevated values of factor VIII related antigen, factor VIII coagulant activity and von Willebrand factor suggested a potential danger of thrombosis in such treated patients.

The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels

“…A partial return of count was observed at the end of 24 hours and baseline levels recorded after 48 hours, as previously reported [22,23]. No overshoot thrombocytosis was noted in our patients, and normal levels were maintained, even on the twice weekly exchange programme.…”

The Complications of Therapeutic Plasma Exchange

“…The incident of he molysis in the cell separator secondary to the used of one-half normal saline solution for priming could have been serious to the pa tient. Fortunately the hemolysis was noted immediately, before any of the blood or tithrombin III has been suggested as a cause for unexpected clotting in some patients [14], We did have 2 patients who developed clots in the cell separator if they were not systemically heparinized and 1 patient who suffered a pulmonary embolus which was detected 1 day post-TPE. Antithrombin III levels were not measured on these patients.…”

“…We prefer to use plasma protein solutions for fluid replacement and thereby avoid the side effects associated with fresh frozen plasma, including hepatitis and allergic reactions. We have not encountered any bleeding post-TPE although others have expressed con cern about the depletion of platelets and coagulation factors [10][11][12][13][14], Depletion of an TPE is a procedure which is gaining in popularity. Although it is relatively safe, it is not without risks.…”

Plasma exchange: Why we do what we do

“…Larger volumes processed and low-rpm speeds (decreased centrifugal force) are associated with greater platelet loss. Despite mean decreases in platelet counts of 52.6% following 1.6 plasma volume exchanges, Sultan et al found that the platelets (as well as all clotting factors measured with the exception of AT III) had almost reached or even exceeded their initial values after 48 to 96 hours (just before the next plasma exchange) [7]. We have also observed 4 normal platelet counts 48 hours after 1-plasma volume exchanges (just prior to the next plasma exchange).…”