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. 2016;2(1):31.
doi: 10.1186/s40981-016-0058-1. Epub 2016 Oct 19.

Therapeutic plasma exchange in heart transplantation: role of coagulation assessment with thromboelastometry

Andrew Crabbe  1 , John S McNeil  2 , Seema P Deshpande  1 , Zachary Kon  3 , Si M Pham  3 , Kenichi A Tanaka  1
Affiliations

Therapeutic plasma exchange in heart transplantation: role of coagulation assessment with thromboelastometry

Andrew Crabbe et al. JA Clin Rep. 2016.

Abstract

Therapeutic plasma exchange (TPE) is a potentially life-saving procedure which effectively removes donor-specific human leukocyte antigen (HLA) antibodies from the bloodstream, allowing critically ill heart transplant recipients to receive a donor organ with less wait time, and reducing the risk of acute organ rejection. The bulk of coagulation factors is initially removed from the blood during TPE using albumin and is later replaced with allogeneic plasma. Coagulopathy may develop during TPE and then can persist due to intraoperative blood loss and hemodilution during surgery and cardiopulmonary bypass. We hereby describe the utility of rotational thromboelastometry to assess rapid coagulation changes during TPE and subsequent heart transplant (HT) surgery.

Keywords: Coagulation; Coagulation factor deficiency; Fresh frozen plasma; Heart transplantation; Plasma exchange.

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Figures

Fig. 1
Fig. 1
a Key parameters of EXTEM-CT: clotting time (s) [normal, 43–82 s], EXTEM-A10: 10 min amplitude (mm) [normal, 43–65 mm], and FIBTEM-A10 [normal, 9–24 mm]. b–d EXTEM and FIBTEM changes during and after therapeutic plasma exchange (TPE). Baseline fibrinogen was in supra-normal range (b), but it extensively decreased after TPE with albumin (c) and even after plasma replacement during surgery. Fibrinogen was restored only after the transfusion of cryoprecipitate (d)
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References

    1. Winters JL. Plasma exchange: concepts, mechanisms, and an overview of the American Society for Apheresis guidelines. Hematology. 2012;2012:7–12. - PubMed
    1. Roman PE, DeVore AD, Welsby IJ. Techniques and applications of perioperative therapeutic plasma exchange. Current Opin Anaesthesiol. 2014;27:57–64. doi: 10.1097/ACO.0000000000000037. - DOI - PubMed
    1. Issitt RW, Crook RM, Cross NT, Shaw M, Robertson A, Burch M, Hsia TY, Tsang VT. Incompatible ABO-plasma exchange and its impact on patient selection in paediatric cardiac transplantation. Perfusion. 2012;27:480–5. doi: 10.1177/0267659112453076. - DOI - PubMed
    1. Tinckam KJ, Keshavjee S, Chaparro C, Barth D, Azad S, Binnie M, Chow CW, de Perrot M, Pierre AF, Waddell TK, Yasufuku K, Cypel M, Singer LG. Survival in sensitized lung transplant recipients with perioperative desensitization. Am J Transplant. 2015;15:417–26. doi: 10.1111/ajt.13076. - DOI - PubMed
    1. O'Brien KL, Price TH, Howell C, Delaney M. The use of 50 % albumin/plasma replacement fluid in therapeutic plasma exchange for thrombotic thrombocytopenic purpura. J Clin Apher. 2013;28:416–21. doi: 10.1002/jca.21288. - DOI - PubMed

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