MO189OUTCOMES OF AN ACCELERATED CITRATE ANTIGOAGULATED MEMBRANE SEPARATION PLASMA EXCHANGE ALGORITHM

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Michael Halpin ◽  
Bonny Chen ◽  
Richard Singer
Keyword(s):  
Plasma Exchange ◽  
Treatment Time ◽  
Fresh Frozen Plasma ◽  
Calcium Flux ◽  
Regional Citrate Anticoagulation ◽  
Similar Frequency ◽  
Citrate Anticoagulation ◽  
Ionised Calcium ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Background and Aims Plasma exchange is a standard therapy for some anti glomerular basement membrane disease and some types of renal transplant rejection. As with other extracorporeal therapies, anticoagulation is usually required. This study assessed the safety, efficacy and Calcium flux of an accelerated algorithm for regional citrate anticoagulation in membrane-based plasma exchange. Method This was an observational study in patients receiving citrate anticoagulated, membrane-based, plasma exchange at the Canberra Hospital between July 2017 and May 2020. Data was collected prospectively using an electronic medical record and compared to data from our previously published algorithm which had used a slower blood pump speed. Results There were 134 plasma exchange sessions performed during the observational period. Circuit clotting occurred in 4 sessions and 1 session was affected by symptomatic hypocalcaemia. A systemic ionised calcium <0.96 mmol/L was seen in 19.4% of sessions, which was a similar frequency to that seen in our previous algorithm. A systemic ionised Ca <0.81 mmol/L occurred in 4 sessions (all asymptomatic). This hypocalcaemia occurred towards the end of the sessions, after switching from albumin to fresh frozen plasma replacement fluid. Median treatment time was 135 minutes, compared to 219 minutes in our previously published algorithm. Mean net Ca gain/session was 7.7 ± 2.3 mmol. Conclusion An accelerated algorithm for regional citrate anticoagulation achieves substantial time savings while maintaining efficacy and safety. The 4 episodes of systemic ionised calcium <0.81 mmol/L may have been due to recirculation of infused citrate but, probably more likely, are due to the additional citrate load imposed by use of fresh frozen plasma in these sessions. Future algorithms need to better account for the citrate load present in fresh frozen plasma.

Efficacy, Safety, and Calcium Balance of an Accelerated Citrate Anticoagulated Membrane-Based Plasma Exchange Algorithm

2021 ◽  
pp. 1-5
Author(s):  
Michael Robert Halpin ◽  
Bonny Chen ◽  
Richard Francis Singer
Keyword(s):  
Plasma Exchange ◽  
Fresh Frozen Plasma ◽  
Calcium Flux ◽  
Ionized Calcium ◽  
Regional Citrate Anticoagulation ◽  
Calcium Balance ◽  
Similar Frequency ◽  
Citrate Anticoagulation ◽  
Fresh Frozen ◽  
Frozen Plasma

<b><i>Introduction:</i></b> To assess the safety, efficacy, and calcium flux of an accelerated algorithm for regional citrate anticoagulation in membrane-based plasma exchange. <b><i>Methods:</i></b> This was an observational study in patients receiving citrate anticoagulated, membrane-based plasma exchange at the Canberra Hospital between July 2017 and May 2020. Data were collected prospectively using an electronic medical record and compared to data from our previous published algorithm. <b><i>Results:</i></b> There were 134 plasma exchange sessions performed during the observational period. Circuit clotting occurred in 4 sessions, and 1 session was affected by symptomatic hypocalcaemia. A systemic ionized calcium &#x3c;0.96 mmol/L was seen in 19.4% of sessions, which was a similar frequency to that seen in our previous algorithm. A systemic ionized Ca &#x3c;0.81 mmol/L occurred in 4 sessions (all asymptomatic). This hypocalcaemia occurred towards the end of the sessions, after switching from albumin to fresh frozen plasma replacement fluid. Median treatment time was 135 min, compared to 219 min in our previously published algorithm. Mean net Ca gain/session was 7.7 ± 2.3 mmol. <b><i>Conclusion:</i></b> An accelerated algorithm for regional citrate anticoagulation achieves substantial time saving while maintaining efficacy and safety. The 4 episodes of systemic ionized calcium &#x3c;0.81 mmol/L may have been due to recirculation of infused citrate but, probably more likely, are due to the additional citrate load imposed by use of fresh frozen plasma in these sessions. Future algorithms need to better account for the citrate load present in fresh frozen plasma.

SP787SELECTIVE PLASMA EXCHANGE IN ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION: EFFICACY OF PARTIAL SUBSTITUTION WITH FRESH FROZEN PLASMA

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Toshihide Naganuma ◽  
Yoshiaki Takemoto ◽  
Ako Hanaoka ◽  
Junji Uchida ◽  
Tatsuya Nakatani
Keyword(s):  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Fresh Frozen Plasma ◽  
Partial Substitution ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Effects of fresh-frozen plasma and its cryosupernatant fraction on von Willebrand factor multimeric forms in chronic relapsing thrombotic thrombocytopenic purpura

Blood ◽  
1985 ◽  
Vol 65 (5) ◽  
pp. 1232-1236 ◽  
Author(s):  
JL Moake ◽  
JJ Byrnes ◽  
JH Troll ◽  
CK Rudy ◽  
SL Hong ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Fresh Frozen Plasma ◽  
Plasma Samples ◽  
Fresh Frozen ◽  
Normal Human ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Frozen Plasma

Abstract Remission plasma samples of some patients with chronic relapsing thrombotic thrombocytopenic purpura (TTP) contain unusually large von Willebrand factor (vWF) multimers similar to those produced by normal human endothelial cells in culture. The infusion of the cryosupernatant fraction of normal plasma is as effective as normal fresh-frozen plasma (FFP) in the treatment or prevention of TTP episodes in patients with the chronic relapsing form of TTP. Three patients with chronic relapsing TTP during remission have unusually large vWF multimers present in their plasma. Two of the patients were transfused once with FFP, one of the two received cryosupernatant on three occasions, and the third patient was studied before and immediately after plasma exchange. Unusually large vWF multimers decreased or disappeared from patient plasma samples within 1/2 to 1 1/2 hours following the transfusion of FFP (on two occasions) or cryosupernatant (on two of three occasions), and immediately after plasma exchange (on one occasion). The patient who received cryosupernatant was studied serially after the infusions. Unusually large vWF multimers returned to her plasma within ten to 24 hours and persisted thereafter. Unusually large vWF multimers did not disappear from patient remission plasma samples, or from the culture medium removed from normal human endothelial cells, when these fluids were incubated in vitro with either normal FFP or cryosupernatant. We conclude that an activity in FFP, and its cryosupernatant fraction, promoted the rapid in vivo disappearance of unusually large vWF multimers from the plasma of two patients with chronic relapsing TTP in remission, and plasma exchange reversed the abnormality in a third patient who was in partial remission. Neither FFP nor cryosupernatant directly converted unusually large multimers to smaller vWF forms in vitro in the fluid phase. These results indicate that an activity in the cryosupernatant fraction of normal plasma is involved in vivo in controlling the metabolism of unusually large vWF multimers, and that this process is defective in some chronic relapsing TTP patients.

Successful treatment of anti-MDA5 antibody-positive refractory interstitial lung disease with plasma exchange therapy

Rheumatology ◽  
2019 ◽  
Vol 59 (4) ◽  
pp. 767-771 ◽  
Author(s):  
Yoshiyuki Abe ◽  
Makio Kusaoi ◽  
Kurisu Tada ◽  
Ken Yamaji ◽  
Naoto Tamura
Keyword(s):  
Survival Rate ◽  
Interstitial Lung Disease ◽  
Adverse Events ◽  
Lung Disease ◽  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Intensive Immunosuppressive Therapy

Abstract Objectives We examined the effectiveness of plasma exchange (PE) therapy to reduce the mortality of rapidly progressive interstitial lung disease (RP-ILD) in patients positive for anti-melanoma differentiation-associated gene 5 (MDA5) antibodies. Methods Among 142 patients newly diagnosed with PM/DM or clinically amyopathic DM from 2008 to 2019 at our hospital, 10 were diagnosed with refractory RP-ILD and were positive for anti-MDA5 antibodies. PE was used as an adjunct to standard therapy and consisted of fresh frozen plasma as replacement solution. The primary outcome was non-disease-specific mortality. Results Anti-MDA5 antibodies were detected in 28 patients, of whom 21 were diagnosed with RP-ILD and 10 were refractory to intensive immunosuppressive therapy. Six patients received PE (PE group) and four did not (non-PE group). The 1-year survival rate of the PE group was higher than that of the non-PE group (100% and 25%, respectively, P = 0.033). Regarding adverse events associated with PE, two patients had anaphylactic shock, one had high fever due to fresh frozen plasma allergy and one had a catheter infection. All adverse events resolved with appropriate treatment. Conclusion We evaluated the association between 1-year survival rate and PE for refractory RP-ILD in patients positive for anti-MDA5 antibodies. Intensive immunosuppressive therapy improved the survival rate in RP-ILD patients with anti-MDA5 antibodies, but 20–30% of cases were still fatal. PE could be administered to patients with active infectious disease who were immunocompromised by intensive immunosuppressive therapy. PE may be considered in refractory RP-ILD patients positive for anti-MDA5 antibodies.

scholarly journals Combination of Fresh Frozen Plasma and Cryosupernatant Plasma for Therapeutic Plasma Exchange in Thrombotic Thrombocytopenic Purpura: A Single Institution Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Qiuyan Lin ◽  
Liping Fan ◽  
Haobo Huang ◽  
Feng Zeng ◽  
Danhui Fu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Fresh Frozen Plasma ◽  
Therapeutic Plasma Exchange ◽  
Dominant Group ◽  
Thrombocytopenic Purpura ◽  
Replacement Fluid ◽  
Fresh Frozen ◽  
Frozen Plasma

Purpose. To evaluate the impact of a combination of fresh frozen plasma (FFP) and cryosupernatant plasma (CP) as a replacement fluid in therapeutic plasma exchange (TPE) on early therapeutic response and long-term survival of patients with thrombotic thrombocytopenic purpura (TTP). Materials and Methods. A total of 44 patients with suspected TTP were screened by Bentley and PLASMIC scores. Twenty-seven patients treated with TPE using the FFP and CP combination as the replacement fluid were enrolled and divided into two groups: 11 patients who received TPE with CP-dominant replacement fluid (FFP/CP<1) and 16 patients who received TPE with FFP-dominant replacement fluid (FFP/CP>1). Results. There were no significant differences in the demographic and clinicopathological characteristics between the two groups except for the international normalized ratio (INR). The number of TPE procedures was lower, and time to achieve complete response was shorter in the CP-dominant group than in the FFP-dominant group. There were no significant differences in overall survival between the two groups. Conclusion. The CP-dominant replacement fluid was superior to the FFP-dominant replacement fluid in early response to TPE in patients with TTP, but did not impact the patients’ overall survival.

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