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Plasmapheresis: Technique and complications

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Abstract

Plasmapheresis has been used in an increasing number of diverse conditions over the past 15 years, and patients on intensive care units are some-times so treated. This article reviews the principles, different techniques and refinements available, including the more specific methods of antibody removal, such as immunoadsorption. The vascular access, anticoagulation, choice of fluid replacement and monitoring requirements are discussed. The reported possible complications of plasmapheresis, relating both to the practical aspects of the procedure and to the effects of plasma removal and the replacement fluids, are reviewed.

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References

  1. Abel JJ, Rowntree LG, Turner BB (1914) Plasma removal with return of corpuscles. J Pharmacol Exp Ther 5:625–641

    Google Scholar 

  2. Sibinga CThS (1986) Apheresis machines and techniques. In: Valbonesi M, Pineda AA, Briggs JC (eds) Therapeutic hemapheresis. Wichtig, Milano, pp 1–8

    Google Scholar 

  3. Mason PD, Pusey CD (in press) Plasma exchange. In: Lachmann PJ, Peters DK, Rosen F, Walport MJ (eds) Clinical aspects of immunology, 5th edn. Blackwell, Oxford

  4. Franz MM, Hamburger MI, Lawley TJ, Kimberley RD, Plotz PJ (1979) Defective reticulo-endothelial system Fc receptor function in systemic lupus erythematosus. N Engl J Med 300:518–523

    Google Scholar 

  5. Lockwood CM, Worlledge SNA, Cotton CH, Peters DK (1979) Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange. N Engl J Med 300:524–530

    Google Scholar 

  6. Machin SJ (1980) Plasma 6-keto-PGF1 levels after plasma exchange in thrombotic thrombocytopenic purpura. Lancet I:661

    Google Scholar 

  7. Rees AJ (1983) Plasma exchange: principles and practice. In: Drukker W, Parsons FM, Maher JF, Nigjoff M (eds) Replacement of renal function by dialysis. Boston, pp 872–883

  8. Wood L, Bond R, Jacobs P (1984) Comparison of filtration to continuous-flow centrifugation for plasma exchange. J Clin Apheresis 2:155–162

    Google Scholar 

  9. Buckner D, Grant RG, Eisel RJ, Henderson ES, Perry S (1969) Leukapheresis by continuous flow centrifugation (CFC) in patients with chronic myelocytic leukaemia (CML). Blood 33:353–369

    Google Scholar 

  10. Buckner D, Eisel R, Perry S (1968) Blood cell separation in the dog by continuous flow centrifugation. Blood 81:653–672

    Google Scholar 

  11. Samtleben W, Randerson DH, Blumenstein M, Habersetzer R, Schmidt B, Gurland HJ (1984) Membrane plasma exchange: principles and application techniques. J Clin Apheresis 2:163–169

    Google Scholar 

  12. Terman DS, Buffaloe G, Mattioli C, Cook G, Tillquist R, Sullivan H, Ayus HC (1979) Extracorporeal immunoabsorption: initial experience in human systemic lupus erythematosus. Lancet II:824–827

    Google Scholar 

  13. Lauterburg BH, Dixon ER, Pineda AA, Carlson GL, Taswell HF (1979) Removal of bile acids and bilirubin by plasmaperfusion of U.S.P. charcoal-coated glass beads. J Lab Clin Med 94:585–592

    Google Scholar 

  14. Burgstaler EA, Pineda AA, Ellefson RD (1980) Removal of plasma lipoproteins from circulating blood with a heparinagarose column. Mayo Clin Proc 55:180

    Google Scholar 

  15. Franceschini G, Busnach G, Vaccanino V, Calabresi L, Gianfranceschi G, Sirtori CR (1988) Aphoretic treatment of severe familial hypercholesterolemia: comparison of dextran sulfate cellulose and double membrane filtration methods for low densitity lipoprotein removal. Atherosclerosis 73:197–202

    Google Scholar 

  16. Homma Y, Mikami Y, Tamachi H, Nakaya N, Nakamura H, Araki G, Goto Y (1986) Comparison of selectivity of LDL removal by double filtration and dextran-sulfate cellulose column plasmapheresis. Atherosclerosis 60:23–27

    Google Scholar 

  17. Mabuchi H, Michishita I, Sakai T, Sakai Y, Watanabe A, Wakasugi T, Takeda R (1986) Treatment of homozygous patients with familial hypercholesterolemia by doublefiltration plasmapheresis. Atherosclerosis 61:135–140

    Google Scholar 

  18. Sprenger KBG, Kratz W, Huber K (1987) Model for individual substitution of immunoglobulins after membrane plasma separation. Nephron 46:231–238

    Google Scholar 

  19. Pearl RG, Rosenthal MH (1985) Metabolic alkaloids due to plasmapheresis. Am J Med 79:391–393

    Google Scholar 

  20. Byrnes JJ, Khurana M (1977) Treatment of thrombotic thrombocytopenic purpura with plasma. N Engl J Med 297: 1386–1389

    Google Scholar 

  21. Oon CJ, Hobbs JR (1975) Medical problems in donors on treatment using the continuous flow blood separator. In: Goldmann JM, Lowenthal RM (eds) Leucocytes: separation, collection and transfusion. Academic Press, London, pp 576–577

    Google Scholar 

  22. Kiprov DD (1985) An overview of therapeutic apheresis. Dial Trans 14:195–202

    Google Scholar 

  23. Huestis DW (1983) Mortality in therapeutic haemapheresis. Lancet I:1043

    Google Scholar 

  24. Puig LI, Mazzara R, Torras A, Castillo R (1985) Adverse effects secondary to the treatment with plasma exchange. Int J Artif Organs 8:155–158

    Google Scholar 

  25. Keller F, Schultze G, Offermann G, Molzahn M (1985) Complications during therapeutic plasma exchange. Acute Care 11:100–105

    Google Scholar 

  26. Sutton DMC, Nairn RC, Rock G and the Canadian Apheresis Study Group (1989) Complications of plasma exchange. Transfusion 29:124–127

    Google Scholar 

  27. Boogaerts MA, Roelant C, Goosens W, Verwilghen RL (1986) Complement activation and adult respiratory distress syndrome during intermittent flow apheresis procedure. Transfusion 26:82–87

    Google Scholar 

  28. Singer D, Cohen J (1982) Safety of plasma exchange. Lancet II:1468

    Google Scholar 

  29. Rubenstein MD, Wall RT, Wood GS, Edwards MA (1983) Complications of therapeutic apheresis including a fatal case with pulmonary vascular occlusion. Am J Med 75:171–174

    Google Scholar 

  30. Buckner CD, Clift RA, Volwiler W, Donolme D, Burnell JM, Saunders FC, Thomas ED (1973) Plasma exchange in patients with fulminant hepatic failure. Arch Intern Med 132:487–492

    Google Scholar 

  31. Hamblin TJ (1979) Plasmapheresis and plasma exchange, vol 1. Eden Press, pp 13–18

  32. Silberstein LE, Naryshkin S, Haddad JJ, Strauss III JF (1986) Calcium homeostasis during therapeutic plasma exchange. Transfusion 26:151–155

    Google Scholar 

  33. Bland JHL, Lawer MB, Lowenstein E (1973) Vasodilator effect of commercial 5% plasma protein fraction solutions. JAMA 224:1721–1724

    Google Scholar 

  34. Rouby JJ, Rottembourg J, Durande JP, Basset JY, Legrain M (1978) Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-haemodialysis. Proc EDTA 15:239–244

    Google Scholar 

  35. Keller AJ, Chirnside A, Urbaniak SJ (1979) Coagulation abnormalities produced by plasma exchange on the cell separator with special reference to fibrinogen and platelets. Br J Haematol 42:593–602

    Google Scholar 

  36. Sultan Y, Bussel A, Maisonneuve P, Poupeney M, Sitty X, Gajdos P (1979) Potential danger of thrombosis after plasma exchange in the treatment of patients with immune disease. Transfusion 19:588–593

    Google Scholar 

  37. Flaum MA, Cuneo RA, Appelbaum FR, Deisseroth AB, Engel WK, Gralnik HR (1979) The hemostatic imbalance of plasma-exchange transfusion. Blood 54:694–702

    Google Scholar 

  38. Chirnside A, Urbaniak SJ, Prowse CV, Keller AJ (1981) Coagulation abnormalities following intensive plasma exchange on the cell separator. Br J Haematol 48:627–634

    Google Scholar 

  39. Orlin JB, Berkman EM (1980) Partial plasma exchange using albumin replacement. Removal and recovery of normal plasma constituents. Blood 56:1055–1059

    Google Scholar 

  40. Toren M, Goffinet JA, Kaplow LS (1970) Pulmonary bed sequestration of neutrophils during hemodialysis. Blood 36:337–340

    Google Scholar 

  41. Keller AJ, Urbaniak SJ (1978) Intensive plasma exchange on the cell separator: effects of serum immunoglobulins and complement components. Br J Haematol 38:531–540

    Google Scholar 

  42. Wing EJ, Bruns FJ, Fraley DS, Segel DP, Sheldon A (1980) Infectious complications with plasmapheresis in rapidly progressive glomerulonephritis. JAMA 244 (21):243–247

    Google Scholar 

  43. Gosh S, Paton L (1985) Complications of therapeutic plasma exchange. Clin Lab Haematol 7:219–224

    Google Scholar 

  44. Wood GJ (1977) Plasmapheresis and plasmacholinesterase. Lancet I:1305

    Google Scholar 

  45. Applegate R, Schwartz D, Bennett WM (1981) Removal of tobramycin during plasma exchange therapy. Ann Intern Med 94:820–821

    Google Scholar 

  46. Stigelman WH, Henry DH, Talbert RL, Townsend RJ (1984) Removal of prednisone and prednisolone by plasma exchange. Clin Pharm 3:402–407

    Google Scholar 

  47. Liu E, Rubenstein M (1982) Phenytoin removal by plasmapheresis in thrombocytopenic purpura. Clin Pharmacol Ther 31: 762–765

    Google Scholar 

  48. White RL, Garnett WR, Poynor W, Allen JH, Sharp DE (1984) Salicylate removal during plasma exchange in normal volunteers. Clin Pharm 3:396–402

    Google Scholar 

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Authors and Affiliations

  1. Renal Unit, Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, W12 ONN, London, UK

    P. M. Reimann &  P. D. Mason

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  1. P. M. Reimann
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  2. P. D. Mason
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Reimann, P.M., Mason, P.D. Plasmapheresis: Technique and complications. Intensive Care Med 16, 3–10 (1990). https://doi.org/10.1007/BF01706318

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