Fibrinogen Reduction and Bleeding Complications in Plasma Exchange, Immunoadsorption and a Combination of the TwoZöllner S.a · Pablik E.b · Druml W.a · Derfler K.a · Rees A.c · Biesenbach P.a
aInternal Medicine III/Clinical Division of Nephrology and Dialysis, bCenter for Medical Statistics, Informatics, and Intelligent Systems, and cClinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
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Background: Immunoadsorption (IAS) and therapeutic plasma exchange (TPE) are considered safe although fibrinogen is removed. To date no comparison of fibrinogen reduction and associated risk of bleeding in apheresis exists. Methods: Retrospective analysis of TPE, three IAS adsorbers, and combined TPE/IAS regarding fibrinogen reduction and bleeding incidence in 67 patients (1,032 treatments). Results: TPE and TPE/IAS reduced fibrinogen by 64 ± 11% and 58 ± 9%, leading to concentrations <100 mg/dl in 20 and 17% of treatments, respectively. IAS decreased fibrinogen less than TPE (26 ± 6%, p < 0.0001), resulting in fibrinogen concentrations <100 mg/dl in 1% of treatments. The processed volume correlated with reduction in TPE (r = 0.64, p < 0.01), but not in IAS. Bleeding occurred in 1.3% (IAS), 2.3% (TPE) and 3.1% (TPE/IAS) of treatments. Conclusion: Hypofibrinogenemia occurs in 20% of patients after TPE and TPE/IAS, but rarely after IAS. IAS removes fibrinogen independently of volume processed. Overall, bleeding is rare in apheresis.
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- Berlot G, Tomasini A, Silvestri L, Gullo A: Plasmapheresis in the critically ill patient. Kidney Int Suppl 1998;66:S178-S181.
- Brunskill SJ, Tusold A, Benjamin S, Stanworth SJ, Murphy MF: A systematic review of randomized controlled trials for plasma exchange in the treatment of thrombotic thrombocytopenic purpura. Transfus Med 2007;17:17-35.
- Bosch T: Therapeutic apheresis - state of the art in the year 2005. Ther Apher Dial 2005;9:459-468.
- Orlin JB, Berkman EM: Partial plasma exchange using albumin replacement: removal and recovery of normal plasma constituents. Blood 1980;56:1055-1059.
- Chirnside A, Urbaniak SJ, Prowse CV, Keller AJ: Coagulation abnormalities following intensive plasma exchange on the cell separator. II. Effects on factors I, II, V, VII, VIII, IX, X and antithrombin III. Br J Haematol 1981;48:627-634.
- Keller AJ, Chirnside A, Urbaniak SJ: Coagulation abnormalities produced by plasma exchange on the cell separator with special reference to fibrinogen and platelet levels. Br J Haematol 1979;42:593-603.
- Yeh JH, Chiu HC: Coagulation abnormalities in serial double-filtration plasmapheresis. J Clin Apher 2001;16:139-142.
- Bornikova L, Peyvandi F, Allen G, Bernstein J, Manco-Johnson MJ: Fibrinogen replacement therapy for congenital fibrinogen deficiency. J Thromb Haemost 2011;9:1687-1704.
Friedman KD, Menitove JE: Preparation and clinical use of plasma and plasma fractions; in Beutler E, Lichtman MA, Coller BS, al. e (eds): Williams' hematology. New York, McGraw-Hill, 2001, pp 1917.
- Holland LL, Foster TM, Marlar RA, Brooks JP: Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion 2005;45:1234-1235.
- Stummvoll GH, Aringer M, Smolen JS, Schmaldienst S, Jimenez-Boj E, Horl WH, Graninger WB, Derfler K: IgG immunoadsorption reduces systemic lupus erythematosus activity and proteinuria: a long-term observational study. Ann Rheum Dis 2005;64:1015-1021.
- Lorenz M, Regele H, Schillinger M, Kletzmayr J, Haidbauer B, Derfler K, Druml W, Bohmig GA: Peritransplant immunoadsorption: a strategy enabling transplantation in highly sensitized crossmatch-positive cadaveric kidney allograft recipients. Transplantation 2005;79:696-701.
- Haas M, Mayr N, Zeitlhofer J, Goldammer A, Derfler K: Long-term treatment of myasthenia gravis with immunoadsorption. J Clin Apher 2002;17:84-87.
- Greenberg SA: Proposed immunologic models of the inflammatory myopathies and potential therapeutic implications. Neurology 2007;69:2008-2019.
- Biesenbach P, Schmaldienst S, Smolen JS, Horl WH, Derfler K, Stummvoll GH: Immunoadsorption in SLE: three different high affinity columns are adequately effective in removing autoantibodies and controlling disease activity. Atheroscler Suppl 2009;10:114-121.
- Palareti G, Maccaferri M, Manotti C, Tripodi A, Chantarangkul V, Rodeghiero F, Ruggeri M, Mannucci PM: Fibrinogen assays: a collaborative study of six different methods. C.I.S.M.E.L. Comitato Italiano per la Standardizzazione dei Metodi in Ematologia e Laboratorio. Clin Chem 1991;37:714-719.
- O'Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM: Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004;126:11-28.
- Bramlage CP, Schroder K, Bramlage P, Ahrens K, Zapf A, Muller GA, Koziolek MJ: Predictors of complications in therapeutic plasma exchange. J Clin Apher 2009;24:225-231.
- Shemin D, Briggs D, Greenan M: Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher 2007;22:270-276.
- Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z: Complications of therapeutic plasma exchange: experience with 4857 treatments. Ther Apher Dial 2005;9:391-395.
- Palo R, Capraro L, Hovilehto S, Koivuranta M, Krusius T, Loponen E, Mantykoski R, Pentti J, Pitkanen O, Raitakari M, Rimpilainen J, Salmenpera M, Salo H, Maki T: Population-based audit of fresh-frozen plasma transfusion practices. Transfusion 2006;46:1921-1925.
- Stanworth SJ, Walsh TS, Prescott RJ, Lee RJ, Watson DM, Wyncoll D; Intensive Care Study of Coagulopathy (ISOC) investigators: A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time. Crit Care 2011;15:R108.
- Narick C, Triulzi DJ, Yazer MH: Transfusion-associated circulatory overload after plasma transfusion. Transfusion 2012;52:160-165.
- Silliman CC, Boshkov LK, Mehdizadehkashi Z, Elzi DJ, Dickey WO, Podlosky L, Clarke G, Ambruso DR: Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 2003;101:454-462.
- Kozek-Langenecker S, Sorensen B, Hess JR, Spahn DR: Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review. Crit Care 2011;15:R239.
- Pilgeram L: Control of fibrinogen biosynthesis: role of the FFA/albumin ratio. Cardiovasc Eng 2010;10:78-83.
- Heigl F, Hettich R, Suckfuell M, Luebbers CW, Osterkorn D, Osterkorn K, Canis M: Fibrinogen/LDL apheresis as successful second-line treatment of sudden hearing loss: a retrospective study on 217 patients. Atheroscler Suppl 2009;10:95-101.
- Bolton-Maggs PH, Perry DJ, Chalmers EA, Parapia LA, Wilde JT, Williams MD, Collins PW, Kitchen S, Dolan G, Mumford AD: The rare coagulation disorders - review with guidelines for management from the United Kingdom Haemophilia Centre Doctors' Organisation. Haemophilia 2004;10:593-628.
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