Spectra Optia apheresis system: experience with secondary plasma devices

Abstract

Abstract:Performing clinical procedures and optimal management of Spectra Optia in combination with secondary plasma devices (SPDs) have not been described in the literature. To contribute to this topic, we examined 300 data log files from patients treated with the Spectra Optia from November 2015 until October 2016. Of these 300 procedures, 149 secondary plasma treatments were conducted in 13 patients (76 immunoadsorption [IA] and 73 lipoprotein apheresis [LA]). Nine patients had IA due to transplantation and autoimmune diseases. Four patients were treated with LA after heart transplantation. Of the procedures, 62% were performed using peripheral venous access, even in patients with a low inlet blood flow. A central catheter was required only in 15% cases, and an arteriovenous fistula in 23% of the procedures. Anticoagulation management differed in both procedures. The LA procedures required a higher amount of citrate as they were performed using only citrate. The IA procedures required less citrate because a mixture of citrate and heparin was used. We did not observe clotting or bleeding, regardless of heparin use. Due to strict calcium management, no patient showed signs of hypocalcemia. Despite our apheresis management, four procedures had to be canceled preliminarily due to patient complications. The targeted substances could be reduced significantly: lipoprotein (a) (Lpa) level by 68% (76%-45%), low-density lipoprotein-cholesterol by 57% (64%-37%), and IgG from 6.6 (1.09-21.0) to 2.61 (0.33-14.7) g/l. The Cobe could be replaced by the Optia system effectively. The Optia has a high plasma extraction efficiency, which allows SPD procedures with peripheral venous access and moderate inlet flow rates.

Spectra Optia^® Apheresis System: current insights into clinical risks and benefits

“…SPO SPD-LA treatments achieved a removal efficiency of lipoproteins like LDL cholesterol and lipoprotein up to 59% and 64%, respectively, compared with baseline. 21,22 Particularly, no cardiac events were observed. In SPO SPD-IA, there are almost no published clinical outcome data.…”

“…In the section of plasma-based therapeutic apheresis with secondary plasma device (SPD), 2 regimens are demonstrated. 21,22 It should be noted that platelet loss in plasma exchange treatments with SPO is not uniformly presented in the literature. Kes et al described a relatively high platelet loss (Table 2) when using a high inlet flow rate greater than 80 mL/min.…”

“…In a recent PubMed search, only 2 reports regarding SPD were found. 21,22 Handschel et al described a new protocol for LA with SPO. 21 For LA, the authors used dextran sulfate-adsorption cellulose (Kaneka, Osaka, Japan) or the IA method (Pocard, Moscow, Russia) in combination with the ADAsorb ® devices (Medicap, Ulrichstein, Germany).…”

“…26 International Rummler et al used the pore size filter technology with Monet ® (Fresenius Medical Care, Homburg, Germany) or Evaflux TM (Kawasumi, Tokyo, Japan) for LA and the adsorption matrix sepharose with coated staphylococcal protein A, Immunosorba ® (Fresenius Medical Care), for IA. 22 They also worked with the ADAsorb ® device (Medicap). The anticoagulation regime in LA was realized with ACD-A alone (ratio of whole blood: ACD-A, 12:1).…”

“…The dosage of prophylactic intravenous calcium gluconate administered was 0.029 mmol/min (0-0.047 mmol/min) in LA and 0.033 mmol/min (0-0.052 mmol/min) in IA. 22 Red blood cell exchange (RBCX) and/or RBC depletion (RBCD)…”