Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;35(1):41-49.
doi: 10.1002/jca.21758. Epub 2019 Nov 12.

Optimizing management of replacement fluids for therapeutic plasma exchange: Use of an automated mathematical model to predict post-procedure fibrinogen and antithrombin levels in high-risk patients

Ray Zhang  1 , Aaron B Dahl  2 , Bryan Marchant  3 , Ronald R Jackups Jr  1 , Hope E Karnes  4 , Priyank Shah  1 , Marian Dynis  5 , Suzanne R Thibodeaux  1 , George J Despotis  1   6
Affiliations

Optimizing management of replacement fluids for therapeutic plasma exchange: Use of an automated mathematical model to predict post-procedure fibrinogen and antithrombin levels in high-risk patients

Ray Zhang et al. J Clin Apher. 2020 Jan.

Abstract

Background: Therapeutic plasma exchange (TPE) utilizes an extracorporeal circuit to remove pathologic proteins causing serious illness. When processing a patient's entire blood volume through an extracorporeal circuit, proteins responsible for maintaining hemostatic system homeostasis can reach critically low levels if replacement fluid types and volumes are not carefully titrated, which may increase complications.

Methods: The charts from 27 patients undergoing 46 TPE procedures were reviewed to evaluate the accuracy of our predictive mathematical model, utilizing the following patient information: weight, hematocrit, pre- and post-TPE factor levels (fibrinogen, n = 46, and antithrombin, n = 23), process volume and volumes of fluids (eg, plasma, albumin, and normal saline) administered during TPE and adverse events during and after TPE.

Results: Altogether, 25% of patients experienced minor adverse events that resolved spontaneously or with management. There were no bleeding or thrombotic complications. The mean difference between predicted and measured post-TPE fibrinogen concentrations was -0.29 mg/dL (SD ±23.0, range -59 to 37), while percent difference between measured and predicted fibrinogen concentration was 0.94% (SD ±10.8, range of -22 to 19). The mean difference between predicted and measured post-TPE antithrombin concentrations were 0.89% activity (SD ±10.0, range -23 to 14), while mean percent difference between predicted and measured antithrombin concentrations was 3.87% (SD ±14.5, range -25 to 38).

Conclusions: Our model reliably predicts post-TPE fibrinogen and antithrombin concentrations, and may help optimize patient management and attenuate complications.

Keywords: chronic illness; coagulopathy; critical illness; therapeutic plasma exchange.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

REFERENCES

    1. Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for apheresis: the seventh special issue. J Clin Apher. 2016;31(3):149-162.
    1. McCarthy L. Plasmapharesis-the Indiana connection. Transfus Sci. 1990;11:161-177.
    1. Gerhardt RE, Ntoso KA, Koethe JD, et al. Acute plasma separation with hemodialysis equipment. J Am Soc Nephrol. 1992;2:1455-1458.
    1. Samtleben W, Randerson DH, Blumenstein M, et al. Membrane plasma exchange: principles and application techniques. J Clin Apheresis. 1984;2(2):163-169.
    1. Wood L, Bond R, Jacobs P. Comparison of filtration to continuous-flow centrifugation for plasma exchange. J Clin Apheresis. 1984;2(2):155-162.

LinkOut - more resources