Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective

Agreda-Vásquez, Gladys Patricia; Espinosa-Poblano, Irma; Sánchez-Guerrero, Sergio Arturo; Crespo-Solís, Erick; Cabrera-Vásquez, Siram; López-Salmorán, Josefa; Barajas, J. D. G.; Peñaloza-Ramírez, Paula; Tirado-Cárdenas, Nelly; Velázquez, Antonio

doi:10.1002/jca.20175

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…In terms of benefits according to each replacement solution, 5% albumin can decrease the risk of viral infections and anaphylactic reactions [3, 5, 6]; FFP contains all the noncellular components of normal blood and does not lead to postapheresis coagulopathy or immunoglobulin depletion [2, 4, 6]; and plasma expanders based on synthetic gelatins have been used safely in TPE with fewer changes in coagulation, but with similar changes in immunoglobulin levels as observed with albumin [3, 12, 13]. A study published in 2015 showed that patients who received albumin as replacement fluid and those in whom prophylactic sodium bicarbonate was not performed presented more adverse events [14].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange as Management of Complicated Systemic Lupus Erythematosus and Other Autoimmune Diseases

Aguirre-Valencia

Naranjo-Escobar

Posso-Osorio

et al. 2019

Autoimmune Diseases

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Introduction. Autoimmune diseases include a diverse and complex group of pathologies with a broad clinical spectrum due to the production of autoantibodies, which generates multisystemic compromise. Therapeutic plasma exchange (TPE) is a good additive treatment for immunosuppression due to its action over the autoantibodies. Objectives. To describe the main clinical characteristics and outcomes of patients with systemic lupus erythematosus and other systemic autoimmune diseases managed with TPE. Methodology. This descriptive retrospective study enrolled patients with systemic autoimmune diseases who received TPE. Results. In total, 66 patients with a median age of 33.5 years (24-53 years) were included; the majority were females [n=51 (77.27%)]. Forty (60.61%) patients were diagnosed with systemic lupus erythematosus. In these cases, the main indication for TPE was diffuse alveolar hemorrhage (DAH; n=20, 30.3%) and neurolupus (n=9, 13.6%). No TPE-related deaths occurred, and the main complication was hemorrhage, without significant differences among the four types of TPE solutions used. The overall outcome was improvement in 41 (62.12%) patients. Conclusion. TPE is safe and effective in patients with severe manifestations of autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

Therapeutic Plasma Exchange as Management of Complicated Systemic Lupus Erythematosus and Other Autoimmune Diseases

Aguirre-Valencia

Naranjo-Escobar

Posso-Osorio

et al. 2019

Autoimmune Diseases

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“…Therefore, clinicians are actively searching for plasma substitutes. Agreda et al used the hydroxyethy starch combined with albumin as a replacement solution in the initial replacement in PE.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

Yao

Zhou

et al. 2019

J of Clinical Apheresis

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Objective The artificial liver support system (ALSS) is used frequently as a first‐line treatment for hepatitis B virus‐associated acute‐on‐chronic liver failure (HBV‐ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half‐dose plasma exchange (PE) (DPMAS+PE) and full‐dose PE in patients with HBV‐ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV‐ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28‐days liver transplant‐free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 ± 9.4% vs 42.3 ± 7.2%, P < 0.05; 24.2 ± 10.0% vs 13.5 ± 13.0%, P < 0.05; 24.8 ± 13.1% vs 14.9 ± 14.9%, P < 0.05; respectively). The 28‐days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28‐days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate‐advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28‐days survival rates in HBV‐ACLF patients with intermediate‐advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV‐ACLF patients.

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“…The type and number of fresh frozen plasma (FFP) units were provided by the French Blood Establishment (Établissement Français du Sang), depending on available stocks. When 4% albumin (A) was used as the replacement fluid, a small proportion of hydroxyethylstarch (HES) was included at the beginning of the TPE session, as recommended 14,15 …”

Section: Methodsmentioning

confidence: 99%

Tolerance and complications of therapeutic plasma exchange by centrifugation: A single center experience

Coirier

Lesouhaitier

Reizine

et al. 2021

J of Clinical Apheresis

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Introduction Therapeutic plasma exchange (TPE) constitutes an important therapy for hematological, neurological, immunological, and nephrological diseases. Most studies have focused on efficacy, whereas tolerance and complications during sessions have been less well studied and not recently. Material and methods We conducted a single center retrospective study of all patients who underwent TPE between 2011 and 2018. TPE sessions using the centrifugation technique were performed by dedicated trained nurses. Specific side effects were identified through surveillance forms completed contemporaneously. The primary outcome was the rate of all‐type adverse effects that occurred during the TPE sessions. Results In total, 1895 TPE sessions performed on 185 patients were analyzed. At least one adverse effect was reported for 805 sessions (42.5% [29.9%‐70.1%]), corresponding to 171 patients (92.4% [87.6%‐95.8%]). Hypotension occurred during 288 sessions (15.2%), was asymptomatic in 95.8% of cases, and more frequent with the use of 4% albumin than fresh frozen plasma (FFP) (19.8 vs 8.9%, P <.0001). Hypocalcemia occurred during 370 sessions (19.6%) and was more frequent with the use of FFP than with the use of albumin alone (FFP alone: 28.0%, albumin + FFP: 26%, albumin alone: 11.7%; P <.0001). Allergic reactions occurred during 56 sessions (3%), exclusively with FFP. Severe adverse effects were reported for 0.3% of sessions and 5.4% of patients. Conclusions TPE is a safe therapy when performed by a trained team. Adverse effects were frequent but mostly not serious. The replacement fluid was the main determinant of the occurrence of complications. (ClinicalTrials.gov ID: NCT03888417).

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Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective

Abstract: TPE with a mixture of 3% HES and 5% human albumin is as effective and safe as 5% human albumin alone for patients with these diseases.

Cited by 14 publications

References 16 publications

Therapeutic Plasma Exchange as Management of Complicated Systemic Lupus Erythematosus and Other Autoimmune Diseases

Therapeutic Plasma Exchange as Management of Complicated Systemic Lupus Erythematosus and Other Autoimmune Diseases

Therapeutic effect of double plasma molecular adsorption system and sequential half‐dose plasma exchange in patients with HBV‐related acute‐on‐chronic liver failure

Tolerance and complications of therapeutic plasma exchange by centrifugation: A single center experience

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