Washout kinetics of colloidal starch as a partial or full replacement for plasma exchange

Brecher, Mark E.; Owen, H.

doi:10.1002/(sici)1098-1101(1996)11:3<123::aid-jca1>3.0.co;2-d

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…Product shortages and rising costs may necessitate the use of nonprotein‐containing solutions as replacement fluids for TPE. Recently, Owen and Brecher have investigated the use of hydroxyethyl starch (Hespan) as a partial or full replacement for albumin. This starch‐based colloid solution is biochemically similar to glycogen rendering it unlikely to engender immune reactions.…”

Section: Starch Replacement For Tpementioning

confidence: 99%

“…The authors concluded that 3% hetastarch was a safe and cost‐effective partial replacement for albumin during TPE. Kinetic modeling of the wash‐out of starch used as a replacement fluid demonstrated that relatively little residual starch remains compared to the total amount infused . As an example, if six successive 4‐L exchanges were performed using only starch as the replacement solution, only 4.1 L of starch (4 L × 6 exchanges × 17% = 4.1 L) would be expected to remain in the circulation despite a total infusion of 24 L (4 L × 6 exchanges = 24 L) of starch.…”

Section: Starch Replacement For Tpementioning

confidence: 99%

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Therapeutic plasma exchange: A technical and operational review

Kaplan

2013

J of Clinical Apheresis

118

129

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Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances. Examples of these substances include pathogenic autoantibodies, immune complexes, cryoglobulins, myeloma light chains, endotoxin and cholesterol containing lipoproteins. The basic premise of the treatment is that removal of these substances will allow for the reversal of the pathologic processes related to their presence. This review will cover the techniques for performing TPE, the kinetics of the removal of large molecules from the plasma and the benefits and risks of the different types of replacement fluids.

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Section: Starch Replacement For Tpementioning

confidence: 99%

Section: Starch Replacement For Tpementioning

confidence: 99%

Therapeutic plasma exchange: A technical and operational review

Kaplan

2013

J of Clinical Apheresis

118

129

View full text Add to dashboard Cite

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“…It is noteworthy that other conceptual mathematical models have generated accurate analyses of clinical issues in transfusion medicine and therapeutic apheresis with similar assumptions. [8][9][10][11][20][21][22][23][24][25][26][27][28][29][30]…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, assessing any detrimental clinical impacts of recirculation as a function of vascular access configuration in tandem ECMO and TPE may also be simultaneously addressed, though this would require a much larger study with a more restricted study population. It is noteworthy that other conceptual mathematical models have generated accurate analyses of clinical issues in transfusion medicine and therapeutic apheresis with similar assumptions 8‐11,20‐30 …”

Section: Discussionmentioning

confidence: 99%

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Puelz

Marinaro

Park

et al. 2020

J of Clinical Apheresis

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Vascular access connection configurations during tandem extracorporeal membrane oxygenation (ECMO) and therapeutic plasma exchange (TPE) may impact exchange kinetics. In these tandem procedures, typically the TPE inlet line is proximal to the TPE return line with respect to blood flow in the ECMO device, maximizing the opportunity for replacement fluid homogenization within the ECMO circuit. However, if TPE inlet and return line connections are switched, recirculation-a phenomenon in which replacement fluid leaving the TPE return line is prematurely drawn into the TPE inlet line prior to satisfactory homogenization within the ECMO circuit-will occur. Such recirculation could diminish TPE efficacy in patients on ECMO and mitigate therapeutic benefits. Using a mathematical model of recirculation in tandem ECMO and TPE, we demonstrate that the predicted impact of recirculation is negligible and vascular access connection positioning does not appear to be a point of clinical concern with regard to TPE kinetics.

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“…Pentastarch also appears to be associated with a lower risk of hypocalcemic toxicity, and may obviate the potential necessity of adding calcium gluconate to the colloid return fluid. Recent work suggests that starch may be safely used in therapeutic plasma exchange [9,10,12] and will not accumulate in body tissues [29], but this requires further confirmation. Given the recent fluctuation in albumin pricing stated in our Introduction, we estimate that by performing all plasma exchange procedures in 1998 according to the experimental arm of our study, our institution would have saved between $127,000 and $434,280, depending on the ambient price of albumin.…”

Section: Discussionmentioning

confidence: 99%

Pentastarch as partial replacement fluid for therapeutic plasma exchange: Effect on plasma proteins, adverse events during treatment, and serum ionized calcium

Goss

Weinstein

1999

J. Clin. Apheresis

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We compared the safety, effect on plasma proteins, and contribution to hypocalcemic toxicity of 10% pentastarch vs. 5% albumin in plasma exchange. Thirty‐two neurology patients underwent 161 plasma exchange procedures. Subjects were randomized to receive either 10% pentastarch (n = 17) or 5% albumin (n = 15) as the first ½ of colloid replacement. The second ½ of colloid replacement was 5% albumin in all cases. NaCl (plus small amounts of ACD‐A) accounted for ¼ of the total return fluid. Mean total exchange volume was 3,842.6 ± 450 ml. Hemoglobin, platelet count, coagulation parameters, and plasma fibrinogen were similar between the two groups at the outset of plasma exchange and at the time of the last (4th or 5th) procedure of the series. Immunoglobulin levels were equivalent at the outset and were reduced by plasma exchange to the same extent in the two groups. Serum albumin concentration fell significantly faster in the group receiving pentastarch. On the other hand, serum calcium, corrected for the albumin concentration, fell significantly further in the control group than in the group receiving pentastarch. Mean serum ionized calcium fell ∼25 % in procedures using only albumin but only ∼16% when pentastarch was used (P < 0.0001). This was reflected in the occurrence of hypocalcemic toxicity in 33.3% of procedures performed using only albumin but in only 8.1% of those using pentastarch (P = 0.0002). Pentastarch may be suitable for partial colloid replacement in plasma exchange and would have saved our hospital $127,050 to $434,280 in 1998 if used in all procedures. J. Clin. Apheresis 14:114–121, 1999. © 1999 Wiley‐Liss, Inc.

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Washout kinetics of colloidal starch as a partial or full replacement for plasma exchange

Cited by 11 publications

References 11 publications

Therapeutic plasma exchange: A technical and operational review

Therapeutic plasma exchange: A technical and operational review

Mathematical modeling of the impact of recirculation on exchange kinetics in tandem extracorporeal membrane oxygenation and therapeutic plasma exchange

Pentastarch as partial replacement fluid for therapeutic plasma exchange: Effect on plasma proteins, adverse events during treatment, and serum ionized calcium

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