Regional citrate anticoagulation vs systemic heparin anticoagulation for double‐filtration plasmapheresis

Teh, Swee Ping; Ho, Quan Yao; Kee, Y. S.; Thangaraju, Sobhana; Tan, Ru Yu; Teo, Su Hooi; Tan, Han Khim; Tan, Chieh Suai; Choong, Hui Lin; Ng, Li Choo; Rahman, Maslinna Abdul; Lim, Amy Ee Lin; Kaushik, Manish

doi:10.1002/jca.22019

Cited by 2 publications

(2 citation statements)

References 34 publications

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“…As expected, both the pH and bicarbonate levels increased among those receiving FFP (pH, 0.04 ± 0.05; bicarbonate, 3.6 ± 3.7 mmol/L) 4 . In addition, Teh et al showed that metabolic acidosis occurred in 41.1% of the 112 TPE sessions in 23 patients 5 . However, it is unclear whether metabolic acidosis was more often seen after multiple TPE sessions.…”

Section: Discussionmentioning

confidence: 58%

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Hyperchloremic metabolic acidosis after plasma exchange in a patient with renal transplant rejection: A case report

Simon,

van Sandwijk,

Olde Engberink

2023

J of Clinical Apheresis

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Therapeutic plasma exchange (TPE) is an effective treatment for several renal disorders, including renal transplant rejection. However, repeated plasma exchanges can result in various metabolic disturbances and complications. We present a 61‐year old male with a medical history of type 2 diabetes, hypertension, successfully treated multiple myeloma, and a post‐mortem kidney transplantation 7 months prior to presentation. The patient was hospitalized with an antibody‐mediated transplant rejection for which treatment with methylprednisolone, TPE with a 40 g/L albumin solution as a replacement fluid, and intravenous immunoglobulins was initiated. After four TPE treatments, the patient developed gastrointestinal complaints and muscle weakness. Despite daily oral bicarbonate supplementation, laboratory tests revealed a hyperchloremic metabolic acidosis: bicarbonate 11.7 mmol/L, chloride 111 mmol/L, and sodium 138 mmol/L. Metabolic acidosis due to citrate accumulation was ruled out with a normal total‐to‐ionized calcium ratio. After treatment with intravenous bicarbonate supplementation, the symptoms disappeared. Analysis of the albumin solution showed a chloride concentration of 132 mmol/L. This is the first case that describes severe metabolic acidosis after multiple sessions of TPE with an albumin solution in a patient with impaired renal function. The hyperchloremic metabolic acidosis is the result of administration of large volumes of an albumin solution with high chloride concentrations. Special attention should be paid to the acid–base balance during TPE in patients with impaired renal function. Future research should investigate the incidence of hyperchloremic metabolic acidosis during TPE in patients with impaired renal function.

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Section: Discussionmentioning

confidence: 58%

“…4 In addition, Teh et al showed that metabolic acidosis occurred in 41.1% of the 112 TPE sessions in 23 patients. 5 However, it is unclear whether metabolic acidosis was more often seen after multiple TPE sessions. Both studies did not report the kidney function of included patients.…”

Section: Discussionmentioning

confidence: 99%

Hyperchloremic metabolic acidosis after plasma exchange in a patient with renal transplant rejection: A case report

Simon,

van Sandwijk,

Olde Engberink

2023

J of Clinical Apheresis

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The Application of Regional Citrate Anticoagulation in Protein A Immunoadsorption: A Single-Center Retrospective Cohort Study

Muhammad,

Hu,

Pan

et al. 2024

Transfus Med Hemother

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Introduction: Protein A immunoadsorption (IA) is proving to be an effective treatment method for autoimmune diseases and other disorders. Regional citrate anticoagulation (RCA) prevents clotting in extracorporeal circuits without increasing hemorrhage risk in high bleeding risk patients, but there are no specific guidelines for its application in IA. We aimed to evaluate the safety and adverse effects of RCA used in IA therapy. Methods: We conducted a retrospective cohort study of forty-five RCA-IA sessions in 14 HLA-incompatible kidney transplant recipients with focus on the safety and adverse effects of RCA in IA. The extracorporeal circuit was equipped with 4% trisodium citrate solution as an anticoagulant and 10% calcium gluconate solution to compensate for calcium loss. The adverse events, including coagulation and blood biochemical indexes, especially calcium level, were recorded. Results: Our study found that 93.33% of the sessions were without circuit clotting or other significant complications. A slight decrease in fibrinogen level was observed, but without significant variations in other coagulation indexes or platelet count. There was a slight elevation in the potential of hydrogen, bicarbonate, and base excess after 2 h and 6 h posttreatment relative to prior treatment, but these returned to normal levels within 24 h posttreatment. Conclusion: RCA is a feasible, effective, and safe anticoagulation option for IA treatment in HLA-incompatible kidney transplant recipients. Electrolyte disturbances, especially alkalosis, hypocalcemia, hypomagnesemia, and fluid status, should be closely monitored and managed.

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Regional citrate anticoagulation vs systemic heparin anticoagulation for double‐filtration plasmapheresis

Cited by 2 publications

References 34 publications

Hyperchloremic metabolic acidosis after plasma exchange in a patient with renal transplant rejection: A case report

Hyperchloremic metabolic acidosis after plasma exchange in a patient with renal transplant rejection: A case report

The Application of Regional Citrate Anticoagulation in Protein A Immunoadsorption: A Single-Center Retrospective Cohort Study

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