Hemolysis in Double-Filtration Plasmapheresis

Abstract

To evaluate the occurrence of hemolysis during double-filtration plasmapheresis (DFP) treatment and its causes, we prospectively treated 113 myasthenic patients and monitored transmembrane pressure (TMP), arterial line pressure (Pa), and venous line pressure (Pv) at 30-minute intervals (M30, M60, M90, and M120) during treatment. Laboratory and clinical parameters related to the development of hemolysis were also analyzed. The overall frequency of hemolysis was 35.4%. Peripheral venous access was associated with a higher rate of hemolysis (45.3%) The mean TMP increased significantly after M30 for the hemolysis group compared with the no hemolysis group. A similar trend was present for Pa. Pv did not differ between the 2 groups during treatments until M90 and M120. Pa and TMP changed significantly with time (both P < .0001). Vascular access through large veins and stable TMP during the procedure may help avoid hemolysis.

Hemolytic events during therapeutic plasma exchange: Root cause analysis

“…noticed higher frequency of 35.4% hemolysis during TPE using double filtration method. [2] Interestingly, hemolytic reaction during TPE has been noted in the United States between 1994 and 1998. [34] However, these reports were due to 25% albumin diluted to 5% albumin with sterile water.…”

“…The case highlights the importance of root cause analysis of possible factors contributing to hemolysis or hemolytic reaction[12] during TPE [Figure 1b]. Quality control checks should be put on human albumin as well as other commercial solutions used in therapeutic apheresis procedures to ensure patient safety.…”

Hemolysis during therapeutic plasma exchange: A rare phenomena

“…Hemolysis is a known complication in patients undergoing plasma exchange using membrane filtration technique with a reported incidence rate as high as 35.4%. 1,2 Hemolysis using membrane filtration technique has been attributed to increased transmembrane pressure resulting in alteration in plasma flow, shearing forces and sieving, thus, leading to hemolysis. 2 However, it is infrequent in procedures performed using the centrifugation method and the only reported cause is the use of 25% albumin diluted to 5% albumin using sterile water as a replacement fluid.…”

“…1,2 Hemolysis using membrane filtration technique has been attributed to increased transmembrane pressure resulting in alteration in plasma flow, shearing forces and sieving, thus, leading to hemolysis. 2 However, it is infrequent in procedures performed using the centrifugation method and the only reported cause is the use of 25% albumin diluted to 5% albumin using sterile water as a replacement fluid. [1][2][3][4] Currently, therapeutic apheresis procedures are being performed using 5% albumin or 20% albumin (reconstituted in normal saline) is being used as replacement fluid.…”

“…2 However, it is infrequent in procedures performed using the centrifugation method and the only reported cause is the use of 25% albumin diluted to 5% albumin using sterile water as a replacement fluid. [1][2][3][4] Currently, therapeutic apheresis procedures are being performed using 5% albumin or 20% albumin (reconstituted in normal saline) is being used as replacement fluid. Here, we report an interesting case where hemolysis was seen during therapeutic plasma exchange (TPE) which was performed using cell separator machine.…”