Anticoagulation Effect and Safety Observation of Regional Citrate Anticoagulation for Double-Filtration Plasmapheresis in Critical Patients

Abstract

Introduction: Double-filtration plasmapheresis (DFPP) is a semi-selective blood purification method based on dual filtration system. Regional citrate anticoagulation (RCA) is an appealing anticoagulation alternative in DFPP. However, there are still few reports on the safety of RCA in DFPP treatment. Objective: To investigate the anticoagulation effect and safety of RCA for DFPP in critical patients. Methods: A total of 34 critical patients treated with DFPP were retrospectively studied. The incidence of coagulation during extracorporeal circulation after single treatment was compared before and after treatment. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood routine indexes, blood gas analysis, peripheral ionic calcium (iCa), total peripheral calcium (TCa), TCa/iCa, and complications before and after single treatment were compared. The changes of transmembrane pressure, pressure drop were measured, and the indexes of coagulation before and after treatment were compared. Results: The blood coagulation <III class in plasma separator and vein ampulla after single DFPP procedure were 96.00 and 94.00%, respectively. There were no statistically significant changes regarding above parameters before and after treatment, except PH, base excess (BE), bicarbonate (HCO 3-), and TCa. Compared with pretreatment levels, PH, BE, and HCO 3 were significantly increased at 5 min and 6 h after treatment (p < 0.05) and restored to the pretreatment levels at 24 h after treatment (p > 0.05). Level of TCa was significantly decreased at 5 min after treatment (p < 0.05), but there was no statistically significant difference at 6 and 24 h (p > 0.05). No treatment-related serious complications were observed in any of the patients. Conclusions: For critical patients who underwent DFPP procedure, RCA is safety and had significant anticoagulation effects, which is worthy of clinical application.

Regional Citrate Anticoagulation during Double-Filtration Plasmapheresis in Kidney Transplant Recipients: A Single-Center Retrospective Cohort Study

“…Maintaining circuit patency is critical for the delivery of extracorporeal therapies since it facilitates the delivery of the prescribed treatment and reduces the risk of complications, unnecessary nursing workload, and treatment cost [8]. Similar to a previous study in non-KTx patients, our study demonstrated that RCA could maintain circuit patency during DFPP, and most sessions were completed without circuit clotting [7]. Suboptimal post-filter iCa and dysfunctional vascular access likely contributed to circuit clotting in our study.…”

“…Suboptimal post-filter iCa and dysfunctional vascular access likely contributed to circuit clotting in our study. Although the achieved postfilter iCa was not reported by Peng et al [7], the lower citrate dose used in our study may have also contributed to higher rates of circuit clotting.…”

“…DFPP has been used for the treatment of active antibody-mediated rejection (ABMR) or desensitization of ABO and/or HLA-incompatible kidney transplants (KTx) [1,[3][4][5]. Anticoagulation is preferred due to the more complex circuit and risks of circuit clotting, but systemic anticoagulation, such as heparin, may be contraindicated for patients with increased bleeding risk (e.g., recent kidney biopsy or surgery) [6][7][8]. Regional citrate anticoagulation (RCA) may be able to maintain circuit patency without exposing the patient to systemic anticoagulation [7,8] but may be associated with complications such as hypocalcemia and acid-base derangements [7,9,10].…”

How to improve clotting factors depletion in double‐filtration plasmapheresis

“…DFPP, a selective form of therapeutic apheresis, is used to treat several pathological conditions that are mainly related to autoimmune disorders 16 . The main side effect of DFPP is the risk of bleeding induced by the loss of coagulation factors 12‐15,17 . To decrease the depletion of coagulation factors, we hypothesized that changing the initial filter that is used to separate blood cells from the plasma (Plasmaflo OP‐08W) with a filter with a smaller‐pore diameter (Cascadeflo EC‐50W) would retain plasma components with a molecular weight greater than ~150 kDa 13 .…”

“…The second filter (Cascadeflo EC‐30 W), which would make it possible to treat the plasma, was the same type in both treatment groups. The regional citrate anticoagulation used is safe and allows effective anticoagulation of the extracorporeal circuit of DFPP 15 …”