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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 08(03): 197-202
DOI: 10.1055/s-0041-1734412
Original Article

Effect of Therapeutic Plasma Exchange on Plasma Constituents in Neurointensive Care Unit Patients: A Retrospective Study

Deepti Srinivas
1   Department of Neuroanaesthesia and Neurocritical Care, Apollo Hospitals, Bangalore, Karnataka, India
,
Kamath Sriganesh
2   Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
,
Dhritiman Chakrabarti 
2   Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
,
Pavithra Venkateswaran
3   Department of Critical Care, Manipal Northside Hospital, Bangalore, Karnataka, India
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Abstract

Purpose Plasma exchange is one of the recommended therapeutic procedures for autoimmune neurological conditions and involves removal of plasma over multiple sessions for exclusion of autoantibodies responsible for the disease process. This study aimed to evaluate the changes in the concentration of plasma constituents with five cycles of alternate day therapeutic plasma exchange (TPE), identify contributing factors for hypoproteinemia, and examine its impact on clinical outcomes.

Methods This was a single-center, retrospective cohort study involving patients with autoimmune neurological diseases who underwent at least five cycles of TPE in the neurointensive care unit (NICU). Data regarding plasma protein concentrations, serum electrolytes, fluid input/output before and after every TPE cycle and clinical outcomes in terms of duration of ventilation, and NICU and hospital stay were collected from the medical records over a 1-year period.

Results The levels of plasma proteins (total protein, albumin and globulin) (p < 0.001), sodium (p < 0.001), calcium (p < 0.001), and hemoglobin (p = 0.002) declined significantly after TPE. Difference in plasma protein levels before and after TPE did not correlate with durations of mechanical ventilation and hospital and NICU stay. Difference in total protein and globulin correlated negatively with fluid balance and positively with daily protein intake (p < 0.05 for both).

Conclusion A significant decrease in plasma proteins and other plasma constituents is seen with TPE. Changes in plasma proteins are related to hemodilution and protein intake. Decrease in plasma proteins did not affect duration of hospital or NICU stay and duration of mechanical ventilation.

Keywords

therapeutic plasma exchange - plasma proteins - neurointensive care unit


Publication History

Article published online:
24 October 2021

© 2021. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Gajdos P, Chevret S, Toyka K. Plasma exchange for myasthenia gravis. Cochrane Database Syst Rev 2002; ( (04) CD002275
    PubMedGoogle Scholar
  • 2 Raphaël JC, Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2002; ;( (02) CD001798
    PubMedGoogle Scholar
  • 3 Nydegger UE. Choice of the replacement fluid during large volume plasma-exchange. Ric Clin Lab 1983; 13 (01) 103-109
    CrossrefPubMedGoogle Scholar
  • 4 Szczepiorkowski ZM, Winters JL, Bandarenko N. et al Apheresis Applications Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice–evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25 (03) 83-177
    CrossrefPubMedGoogle Scholar
  • 5 Szczeklik W, Wawrzycka K, Włudarczyk A. et al Complications in patients treated with plasmapheresis in the intensive care unit. Anaesthesiol Intensive Ther 2013; 45 (01) 7-13
    CrossrefPubMedGoogle Scholar
  • 6 Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence-based guideline update: plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76 (03) 294-300
    CrossrefPubMedGoogle Scholar
  • 7 Filomena CA, Filomena AP, Hudock J, Ballas SK. Evaluation of serum immunoglobulins by protein electrophoresis and rate nephelometry before and after therapeutic plasma exchange. Am J Clin Pathol 1992; 98 (02) 243-248
    CrossrefPubMedGoogle Scholar
  • 8 Goss GA, Weinstein R. Pentastarch as partial replacement fluid for therapeutic plasma exchange: effect on plasma proteins, adverse events during treatment, and serum ionized calcium. J Clin Apher 1999; 14 (03) 114-121
    CrossrefPubMedGoogle Scholar
  • 9 Grgicević D, Pende B. [Effect of long-term plasmapheresis on blood composition. I. Changes in the concentration of total proteins, electrophoretic fractions and immunoglobulins]. Bilt Hematol Transfuz 1981; 9 (1-3) 77-88
    PubMedGoogle Scholar
  • 10 Movshev BE, Petrova VI, Kalinin NN. [Blood protein-volume indicators in massive plasmapheresis]. Gematol Transfuziol 1992; 37 (02) 12-15
    PubMedGoogle Scholar
  • 11 Israël L, Edelstein R, McDonald J, Weiss J, Schein P. Immunological and plasma protein changes in cancer patients following a single plasmapheresis. Biomedicine (Paris 1978; 28 (05) 292-297
    PubMedGoogle Scholar
  • 12 Wahlin A, Grubb A, Holm J, Marklund SL. Effects of plasmapheresis on the plasma concentration of proteins used to monitor the disease process in multiple myeloma. Acta Med Scand 1988; 223 (03) 263-267
    CrossrefPubMedGoogle Scholar
  • 13 Lasky LC, Finnerty EP, Genis L, Polesky HF. Protein and colloid osmotic pressure changes with albumin and/or saline replacement during plasma exchange. Transfusion 1984; 24 (03) 256-259
    CrossrefPubMedGoogle Scholar
  • 14 Ciszewski TS, Ralston S, Acteson D, Wasi S, Strong SJ. Protein levels and plasmapheresis intensity. Transfus Med 1993; 3 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 15 Shanbrom E, Lundak R, Walford RL. Long-term plasmapheresis: effects on specific plasma proteins. Transfusion 1972; 12 (03) 162-167
    CrossrefPubMedGoogle Scholar
  • 16 Kliman A, Carbone PP, Gaydos LA, Freireich EJ. Effects of intensive plasmapheresis on normal blood donors. Blood 1964; 23: 647-656
    CrossrefPubMedGoogle Scholar
  • 17 Kaysen GA, Gambertoglio J, Jimenez I, Jones H, Hutchison FN. Effect of dietary protein intake on albumin homeostasis in nephrotic patients. Kidney Int 1986; 29 (02) 572-577
    CrossrefPubMedGoogle Scholar
  • 18 Barle H, Nyberg B, Essén P. et al The synthesis rates of total liver protein and plasma albumin determined simultaneously in vivo in humans. Hepatology 1997; 25 (01) 154-158
    PubMedGoogle Scholar
  • 19 Imai M, Kokko JP. Effect of peritubular protein concentration on reabsorption of sodium and water in isolated perfused proximal tubules. J Clin Invest 1972; 51 (02) 314-325
    CrossrefPubMedGoogle Scholar
  • 20 Berry CA, Cogan MG. Influence of peritubular protein on solute absorption in the rabbit proximal tubule. A specific effect on NaCl transport. J Clin Invest 1981; 68 (02) 506-516
    CrossrefPubMedGoogle Scholar
  • 21 Weinstein R. Hypocalcemic toxicity and atypical reactions in therapeutic plasma exchange. J Clin Apher 2001; 16 (04) 210-211
    CrossrefPubMedGoogle Scholar
  • 22 Evers J, Ehren N, Engelen T, Hansen M, Luethje K, Taborski U. Course of hemoglobin and hematocrit during and after preparatory plasmaphereses without and with infusion of NaCl 0.9% 500 ml. Transfus Med Hemother 2014; 41 (02) 114-116
    CrossrefPubMedGoogle Scholar
  • 23 Fischer T, Surikova I, Heesen E, Wilms G, Laitinen T, Taborski U. Loss of red cell mass in a plasmapheresis machine: effect of rinsing the disposable tubing with normal saline and reinfusion. Transfus Apheresis Sci 2013; 49 (01) 80-83
    CrossrefPubMedGoogle Scholar