Effect of therapeutic plasma exchange on plasma levels and total removal of adipokines and inflammatory markers

Schmidt, Julius J.; Jahn, Janine; Golla, Paulina; Hafer, Carsten; Kielstein, Jan T.; Kielstein, Heike

doi:10.1186/s40608-015-0067-z

Cited by 11 publications

(8 citation statements)

References 42 publications

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“…If FFP is not the chosen replacement fluid, on top of the removal of disease mediators, plasma exchange could potentially also deplete the patient of important plasma constituents including clotting factors, transport proteins, inflammatory and cardiac biomarkers, adipose tissue–derived hormones, and so forth . Depending on the specific plasma constituent, the removal of it might have a specific impact for the treatment of the underlying disease .…”

Section: Discussionmentioning

confidence: 99%

A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures

et al. 2016

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BACKGROUND Therapeutic plasma exchange (TPE) can be performed either on a membrane‐based system (mTPE) or on a device that separates blood components by centrifugation (cTPE). The number of studies in this field is limited. This randomized study is the first that offers data on the membrane‐based Diapact device (B. Braun Medical, Inc.) for TPE procedures and compares it to the centrifuge‐based Spectra Optia (Terumo BCT, Inc.). STUDY DESIGN AND METHODS Twenty‐seven patients were enrolled in this randomized prospective head‐to‐head study comparing the mTPE and cTPE systems. Procedures on both devices were standardized and the plasma removal efficiency (PRE); total procedure time (including setup and priming time); and removal efficiencies of blood cells, immunoglobulin (Ig)G, and fibrinogen for all procedures were analyzed. RESULTS While both systems removed similar amounts of plasma, it took the cTPE device a mean of 101.5 ± 24.6 minutes to finalize a procedure that was one‐third less than procedures on the mTPE device (157 ± 26.2 min; p < 0.0001), due to a difference in PRE between the Spectra Optia (83.0% ± 4.9%) and the Diapact (53.2% ± 6.6%; p < 0.0001). The difference in removal efficiencies of IgG and blood cells were not significantly different but the Spectra Optia was more efficient in removing the larger fibrinogen protein than the Diapact (72.3% ± 8.5% vs. 62.9% ± 16.1%, respectively; p < 0.02). CONCLUSION This study shows that, although both systems perform adequate and safe TPE procedures, those on the Spectra Optia in comparison to the Diapact are more efficient in terms of plasma removal and significantly shorter.

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Section: Discussionmentioning

confidence: 99%

A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures

et al. 2016

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“…This study included 21 patients with the need for TPE as reported elsewhere [ 12 ]. The inclusion criteria were:…”

Section: Methodsmentioning

confidence: 99%

Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study

et al. 2015

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BackgroundTherapeutic plasma exchange (TPE) is either performed using a highly permeable filter with standard multifunctional renal replacement equipment (mTPE) or a centrifugation device (cTPE). Although both techniques are well established in clinical practice, performance of these two modes of TPE was never compared in a prospective randomized fashion. Thus we aimed to compare two commercially available therapeutic apheresis systems: mTPE (Octonova with Plasmaflo filter) and cTPE (Spectra Optia apheresis system).MethodsTwenty-one patients (age 51.6 ± 13.5 years; 10 F/11 M; BMI 25.1 ± 5.0 kg/m2) were enrolled in this randomized, prospective, paired, crossover study performed in the Hannover Medical School, Germany. First treatment (either mTPE or cTPE) was chosen by an online randomization list. The primary endpoints were plasma removal efficiency with 1.2× of the total plasma volume exchanged. Secondary endpoints were total amount of plasma substances removed, such as IgG and fibrinogen. Further, the treatment effect on platelet count and complications were evaluated.ResultsDespite a comparable volume of the processed plasma, mTPE treatment time was 10.5 % longer than cTPE treatment time (p < 0.05), resulting in a 10 % lower plasma removal rate of the mTPE treatment. Both treatments were comparable in terms of decrease in median (IQR) IgG [pre-mTPE 5.34 (3.48–8.37), post-mTPE 1.96 (1.43–2.84) g/L; pre-cTPE 5.88 (3.42–8.84), post-cTPE 1.89 (1.21–3.52) g/L]. Also the median (IQR) amount of IgG removed in mTPE [13.14 (7.42–16.10) g] was not different from the cTPE treatment [9.30 (6.26–15.69) g]. This was also true for IgM removal. Platelet loss during mTPE was nearly twice as much as with cTPE (15 ± 9 versus 7 ± 9 %, p < 0.05).ConclusionAlthough the centrifugal procedures were conducted using flow rates that could easily be obtained using peripheral access, plasma removal efficiency was significantly higher and treatment time was significantly lower in cTPE as compared to mTPE. Despite this lower treatment time, the decline in markers of procedure efficacy was comparable. Especially in centers performing many procedures per year, cTPE in contrast to mTPE can reduce treatment time without compromising treatment efficacy.

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“…[ 5 ] Moreover, despite the lack of solid data, TPE is used in the intensive care setting for e.g. sepsis with multi organ failure or hypertriglyceridemia induced pancreatitis [ 6 , 7 ] as it removes a plethora of pro-inflammatory cytokines [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic plasma exchange in a tertiary care center: 185 patients undergoing 912 treatments - a one-year retrospective analysis

et al. 2018

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BackgroundTherapeutic plasma exchange (TPE) is increasingly used throughout the world. Although the procedure itself is fairly standardized, it is yet unknown how the underlying disease entities influence the key coordinates of the treatment.MethodsRetrospective chart review. The treatment indications were clustered into four categories. Data are presented as median and interquartile (25–75%) range [IQR].ResultsWithin 1 year, 912 TPE treatments were performed in 185 patients (90 female, 48.6%). The distribution of the treatment numbers to the pre-specified disease categories were as follows: transplantation (35.7%), neurology (31.9%), vasculitis and immunological disease (17.3%), and others including thrombotic microangiopathy (8.1%), critical care related diseases (5.4%), hematology [multiple myeloma] (1.1%), and endocrine disorders (0.5%). The calculated plasma volume was significantly higher in patients with vasculitis and immunological diseases (3984 [3433–4439] ml) as compared to patients treated for transplant related indications (3194 [2545–3658] ml; p = 0.0003) and neurological diseases (3058 [2533–3359] ml; p < 0.0001). This was mainly due to the differences in the hematocrit which was 30.5 [27.0–33.6] % in the vasculitis/immunological disease patients and 40.2 [37.5–42.9] % in the neurological patients; p < 0.0001. Interestingly, treatment time using a membrane based technology was significantly longer than TPE using a centrifugal device 135.0 [125.0–140.0] min vs. 120.0 [112.5–135.0] min. Furthermore, the relative exchanged plasma volume was significantly lower in the treatment of vasculitis and immunological diseases as compared to treatments of transplant related indications and neurological diseases.ConclusionPatients with low hematocrit and high body weight do not receive the minimum recommended dose of exchange volume. Centrifugal TPE allowed faster plasma exchange than membrane TPE.

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Effect of therapeutic plasma exchange on plasma levels and total removal of adipokines and inflammatory markers

Cited by 11 publications

References 42 publications

A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures

A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures

Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study

Therapeutic plasma exchange in a tertiary care center: 185 patients undergoing 912 treatments - a one-year retrospective analysis

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