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, Aaron B. Dahl, Bryan Marchant, Ronald R. Jackups, Hope E. Karnes, Priyank Shah, Marian Dynis, Suzanne R. Thibodeaux, George J. Despotis

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish
Pages (from-to)41-49
Number of pages9
JournalJournal of Clinical Apheresis
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2020

Keywords

  • chronic illness
  • coagulopathy
  • critical illness
  • therapeutic plasma exchange

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this