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

Abstract

One hundred therapeutic plasmaphereses were carried out at biweekly intervals in seven patients, without morbidity or mortality, using the IBM 2997 blood fraction separator. In standardised procedures, 1.5 times the calculated plasma volume was replaced with an electrolyte solution containing 4% salt-free human albumin. Anticoagulation was achieved using a whole venous blood to acid-citrate dextrose ratio of 11 to 1. Median flow rates, plasma collection, and procedure times were respectively 40 ml/minute, 20 ml/minute, and 3 hours. Haemoglobin and total white cell counts were not significantly affected by the procedures. In contrast, platelet count, fibrinogen, immunoglobulin levels, total haemolytic complement, as well as C3 and C4 fractions fell, and the prothrombin and partial thromboplastin times were lengthened by the exchanges. All these measurements had returned to normal within 24 hours, apart from the fibrinogen, which took between 48 and 72 hours, and the immunoglobulin level, which required 35 days to return to baseline. In a further patient, more detailed studies (n = 13) were carried out to characterise the behaviour of antithrombin III and factor VIII. Both levels were markedly reduced immediately following the procedure and, like fibrinogen, had returned to normal within 48 hours. These data indicate that in an isovolemic plasmapheresis there was a transient but rapidly reversible effect on all the factors studied, with fibrinogen level, antithrombin III, and factor VIII returning more slowly to normal than the others, and immunoglobulin levels responding the slowest. None of these changes was associated with clinically significant haemostatic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Powikłania u chorych leczonych metodą plazmaferezy na oddziale intensywnej terapii

“…W przedstawianej pracy wszyscy chorzy, u których zastosowano leczniczą wymianę osocza, byli w ciężkim stanie klinicznym, wymagali leczenia na OIT, a pomimo to metoda ta okazała się skuteczna u 91% chorych, przyczyniając się do ustępowania objawów choroby podstawowej. Zgodnie z doniesieniami pochodzącymi z innych ośrod-ków, najlepszy efekt terapeutyczny uzyskiwano w procesach o podłożu immunologicznym i o ostrym przebiegu, czyli w zespole Guillaina-Barrégo, w przełomie miastenicznym, w ostrym uszkodzeniu nerek w przebiegu zapalenia naczyń czy w ostrej plamicy małopłytkowej i zespole Lyella [15,16,17,18,19]. Plazmafereza jako metoda inwazyjna nie jest wolna od powikłań.…”

Therapeutic plasma exchange for the treatment of pediatric renal diseases in 2013

“…Therapeutic plasma exchange not only removes pathogenic molecules but also normal immunoglobulins, and immunoglobulin levels have been demonstrated to be lower in patients undergoing plasma exchange [128,129]. This does not appear to be associated with a higher rate of infection [128], and levels have been shown to return to baseline after 35 days [129].…”

“…This does not appear to be associated with a higher rate of infection [128], and levels have been shown to return to baseline after 35 days [129]. Some investigators have suggested that FFP supplementation as part of replacement fluids be used in actively infected plasma exchange patients with IgG levels of <100 mg/dL [130].…”

“…Levels of coagulation factors are transiently depleted by TPE without FFP supplementation [129]. Most coagulation factors are rapidly synthesized by the liver, and in patients with normal hepatic function, prothrombin time and partial thromboplastin time normalize within 24 h, and fibrinogen normalizes within 48-72 h [129].…”

“…Most coagulation factors are rapidly synthesized by the liver, and in patients with normal hepatic function, prothrombin time and partial thromboplastin time normalize within 24 h, and fibrinogen normalizes within 48-72 h [129]. Fibrinogen levels should be checked prior to plasma exchange, especially in patients undergoing therapy more frequently than every other day.…”