Therapeutic plasma exchange in patients with severe obesity (BMI >40): A survey of practices in the United States

Abstract

Background: The prevalence of obesity in the United States is estimated at 42.4% and expected to increase over the next decade. Therefore, understanding how to best perform certain medical procedures on severely obese (SO) patients is a necessity. This study presents results on the current methods of performing therapeutic plasma exchange (TPE) on SO patients. This paper aims to contribute to the existing literature by providing new insights into calculating plasma volume (PV) for TPE in SO patients.Methods: Blood Bank/Apheresis Directors at all institutions with pathology residency and/or blood banking/transfusion medicine fellowship programs were asked to complete a 5-question online survey about their institutional policies regarding TPE in SO patients. Survey data were analyzed to determine if institutions have policies in place to calculate PV in SO patients.Results: Out of the 144 institutions contacted, 45 (31%) completed the survey. Nine (20%) institutions had a policy to calculate PV differently for SO patients, 7 (16%) reported a specific body mass index (BMI) above which they alter PV calculation, and 7 (16%) reported a maximum volume exchanged in SO patients. Conclusion:A minority of responding institutions had specific policies in place to calculate PV for TPE in SO patients. Practice patterns for calculating PV for TPE in SO patients varied, with some institutions adjusting PV calculations and others setting a maximum volume to be exchanged regardless of BMI. These findings highlight the need for establishing a clear method of calculating PV in SO patients. K E Y W O R D S actual body weight, body mass index, ideal body weight, plasma volume, severe obesity, therapeutic plasma exchange Shraddha Patel Babariya and Angelica Vivero contributed equally and should both be considered first authors.

Characteristics of Therapeutic Plasma Exchange Procedures in Patients with Myasthenia Gravis and Guillain Barre Syndrome and their Outcomes during Hospitalization in General Intensive Care Unit Hasan Sadikin General Hospital Bandung in January 2017 to December 2020

“…Of the 96 TPE procedures performed, it was found that at the beginning of TPE procedure, there were about 52 cases (54.3%) of hypotension, but after fluid management was given, hypotension could be managed in less than 15 minutes and there was only 1 incident (1%) of untreated hypotension complications. The patient with the hypotension had BMI value of 32 kg/m 2 that according to a previous study in America in 2021, there were difficulties in calculating replacement fluids for obese patients so they conduct a greater risk of hypotension (Babariya et al, 2021). In the GBS group, most complications were of electrolyte disturbances.…”

Severely obese patients and the total blood volume dilemma focus group at the 2022 annual American Society for Apheresis meeting in Philadelphia

“…Dear Editor, A recent publication by Babariya et al 1 in the Journal of Clinical Apheresis described the survey results of the current practices for total blood volume (TBV) calculations for high-BMI patients among 45 academic institutions in the United States. The authors of that publication focused on TBV estimation in severely obese patients with a body mass index (BMI) of over 40 undergoing therapeutic plasma exchange procedures (TPE).…”