TY - JOUR
T1 - Optimizing management of replacement fluids for therapeutic plasma exchange
T2 - Use of an automated mathematical model to predict post-procedure fibrinogen and antithrombin levels in high-risk patients
AU - Zhang, Ray
AU - Dahl, Aaron B.
AU - Marchant, Bryan
AU - Jackups, Ronald R.
AU - Karnes, Hope E.
AU - Shah, Priyank
AU - Dynis, Marian
AU - Thibodeaux, Suzanne R.
AU - Despotis, George J.
N1 - Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
KW - chronic illness
KW - coagulopathy
KW - critical illness
KW - therapeutic plasma exchange
UR - http://www.scopus.com/inward/record.url?scp=85075015833&partnerID=8YFLogxK
U2 - 10.1002/jca.21758
DO - 10.1002/jca.21758
M3 - Article
C2 - 31713919
AN - SCOPUS:85075015833
SN - 0733-2459
VL - 35
SP - 41
EP - 49
JO - Journal of Clinical Apheresis
JF - Journal of Clinical Apheresis
IS - 1
ER -