Juan Pablo Córdoba1, Carolina Larrarte2, María Camila Medina3. 1. Department of Nephrology, Head of the Hemodialysis and Apheresis Program, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia. 2. Department of Nephrology, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogota, Colombia. 3. Renal Unit, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogota, Colombia.
Abstract
INTRODUCTION: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification therapy that is part of the treatment of various diseases. Plasma and blood cells can be separated by centrifugation or using membrane separators. MATERIALS AND METHODS: A descriptive analysis, in which the first 500 TPE sessions using membrane filtration without anticoagulation of the extracorporeal circuit are described. RESULTS: Five hundred (500) TPE sessions were performed on 68 patients over a period of 5 years. Therapeutic indications were 17 different diseases. 5% albumin was the most frequent replacement solution used in 62% of sessions. The mean number of plasma volume replacements was 1.33. Complications occurred in 7.6% of the sessions. Arterial hypotension was the most common event and clotting of the extracorporeal circuit was documented in just one TPE session. Electrolyte tests performed in patients during the procedure showed: 11% hypocalcemia, with a similar distribution of hypokalemia. Twenty-two percent (22%) and 37% of phosphorus and magnesium records, respectively, were higher than normal. No symptoms associated with electrolyte abnormalities were documented. CONCLUSIONS: TPE by membrane filtration is one of the techniques by which it is possible to perform such therapy. In this registry, a low rate of complications was documented. While the need for anticoagulation may be related not only to clotting of the circuit but also to the efficiency of the therapy, clinical response in this series of patients was as expected for each disease. Continuous monitoring and an individualized analysis of electrolytes should be performed in TPE patients.
INTRODUCTION: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification therapy that is part of the treatment of various diseases. Plasma and blood cells can be separated by centrifugation or using membrane separators. MATERIALS AND METHODS: A descriptive analysis, in which the first 500 TPE sessions using membrane filtration without anticoagulation of the extracorporeal circuit are described. RESULTS: Five hundred (500) TPE sessions were performed on 68 patients over a period of 5 years. Therapeutic indications were 17 different diseases. 5% albumin was the most frequent replacement solution used in 62% of sessions. The mean number of plasma volume replacements was 1.33. Complications occurred in 7.6% of the sessions. Arterial hypotension was the most common event and clotting of the extracorporeal circuit was documented in just one TPE session. Electrolyte tests performed in patients during the procedure showed: 11% hypocalcemia, with a similar distribution of hypokalemia. Twenty-two percent (22%) and 37% of phosphorus and magnesium records, respectively, were higher than normal. No symptoms associated with electrolyte abnormalities were documented. CONCLUSIONS: TPE by membrane filtration is one of the techniques by which it is possible to perform such therapy. In this registry, a low rate of complications was documented. While the need for anticoagulation may be related not only to clotting of the circuit but also to the efficiency of the therapy, clinical response in this series of patients was as expected for each disease. Continuous monitoring and an individualized analysis of electrolytes should be performed in TPE patients.
Authors: Nicholas L Zalewski; Alejandro A Rabinstein; Karl N Krecke; Robert D Brown; Eelco F M Wijdicks; Brian G Weinshenker; Timothy J Kaufmann; Jonathan M Morris; Allen J Aksamit; J D Bartleson; Giuseppe Lanzino; Melissa M Blessing; Eoin P Flanagan Journal: JAMA Neurol Date: 2019-01-01 Impact factor: 18.302