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2017 ; 27
(5
): 377-383
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Effect of Double Filtration Plasmapheresis on Various Plasma Components and
Patient Safety: A Prospective Observational Cohort Study
#MMPMID28904434
Jagdish K
; Jacob S
; Varughese S
; David VG
; Mohapatra A
; Valson A
; Tulsidas K
; Veerasami T
; Alexander S
Indian J Nephrol
2017[Sep]; 27
(5
): 377-383
PMID28904434
show ga
Double filtration plasmapheresis (DFPP) was historically used for blood group
incompatible renal transplantation. Very few studies are available worldwide
regarding its efficiency in removing specific plasma components, and safety. We
conducted a prospective observational cohort study over 1 year on patients
undergoing DFPP for various renal indications. There were 15 patients with 39
sessions. The pre- and post-procedure plasma samples of serum IgG, IgA, IgM,
fibrinogen, calcium, phosphate, potassium, and magnesium were analyzed. The
effluent albumin concentration was also measured, and complications during the
hospital stay were recorded. Cumulative removal of serum IgG, IgA, IgM,
fibrinogen, and albumin at the end of four sessions were 72%, 89%, 96%, 88.5%,
and 21.3%, respectively and effluent albumin concentration was 1.75 - 2.0 times
(range: 6.3 g/dl - 7.2 g/dl; mean ± standard deviation (SD) - 7 g/dl ± 0.3 g/dl)
the preprocedural serum albumin (mean ± SD - 3.5 g/dl ± 0.5 g/dl). Removal of
other plasma components were not statistically significant. Hypotensive episodes
were observed only 16.6%, with the usage of effluent concentration albumin as
replacement fluid despite an average 2.4 (mean ± SD - 2.4 ± 0.4 l) liters of
plasma volume processing each session. DFPP removes IgG, IgA, IgM, fibrinogen,
and albumin. The cumulative removal IgG (72%) is suboptimal, whereas IgA (89%)
and IgM (96%) are comparable to historical controls. We observed lesser episodes
(12.5%) of hypotension with effluent albumin concentration as replacement fluid,
and all bleeding complications were observed when serum fibrinogen level was <50
mg/dl.