Partial colloid starch replacement for therapeutic plasma exchange

Therapeutic Apheresis: Basic Principles and Practical Aspects

“…9,42,43,[53][54][55] When coagulant protein-deficient replacement fluids such as albumin, saline, and colloidal starches are used, an acute decrease in clotting factor activity, varying from 40% to 70% of baseline, can be observed immediately after the exchange. 9,42,43,[53][54][55] When coagulant protein-deficient replacement fluids such as albumin, saline, and colloidal starches are used, an acute decrease in clotting factor activity, varying from 40% to 70% of baseline, can be observed immediately after the exchange.…”

Albumin

“…33 Although nonprotein colloids have been associated with side effects such as alterations in hemostatic laboratory results, pruritus, and, rarely, with severe head and back pain, they also are less expensive than albumin and are preferred by some. [34][35][36][37][38][39] In those clinical conditions in which plasma expansion through albumin or nonprotein colloids has demonstrated equivalent patient outcomes, the 2000 UHC guidelines recommend the use of the latter due to their lower cost. Neither crystalloids nor colloids can be substituted for red blood cells when oxygen-carrying capacity is needed or for platelets or plasma when coagulopathy exists.…”

Pentastarch as partial replacement fluid for therapeutic plasma exchange: Effect on plasma proteins, adverse events during treatment, and serum ionized calcium

“…They performed 64 plasma exchanges with hetastarch over 28 months and observed only mild ankle edema toward the end of the treatment course. Owen and Brecher [12] used hetastarch (as a 6 or 3% solution) for the first liter of colloid replacement fluid (33-50% of plasma volume exchanged) in 289 plasma exchange procedures performed on 46 patients. Other than complaints of severe transient back and head pain in 3 patients, and slight peripheral edema in 1 patient, the procedures were well tolerated.…”

“…Other than complaints of severe transient back and head pain in 3 patients, and slight peripheral edema in 1 patient, the procedures were well tolerated. They currently use 3% hetastarch as the first 50% of colloid replacement fluid in selected patients [12] and have observed only a decrease in serum total protein and a modest rise in prothombin time [9].…”

“…In view of these factors, we undertook to further study pentastarch as colloid return fluid in plasma exchange. Following the model of Owen and Brecher for use of hetastarch in plasma exchange [12], we conducted a randomized trial comparing 10% pentastarch to 5% albumin as the first half of colloid return fluid in therapeutic plasma exchange in patients with neurological disorders.…”