Therapeutic Plasma Exchange Decreases Levels of Routinely Used Cardiac and Inflammatory Biomarkers

Tutarel, Oktay; Golla, Paulina; Beutel, Gernot; Bauersachs, Johann; David, Sascha; Schmidt, Bernhard M.W.; Lichtinghagen, Ralf; Kielstein, Jan T.

doi:10.1371/journal.pone.0038573

Cited by 11 publications

(12 citation statements)

References 13 publications

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“…Underlying diseases necessitating TPE were humoral rejection after solid organ transplantation ( n = 8); Guillian–Barré syndrome and variants ( n = 3); monoclonal gammopathy ( n = 2); multiple sclerosis (n = 2); microscopic polyangiitis ( n = 2); rapid progressive glomerulonephritis ( n = 1); cryoglobulinemia ( n = 1); and cytotoxic antibodies ( n = 1). Further patients’ characteristics and details of the procedure are described elsewhere [15]. …”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

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

et al. 2015

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“…The strengths of our study include the homogeneous management (that is, we included patients within a limited period of time, investigated them in the same manner, and recorded their data prospectively) and the large number of centers and medical specialties that participated in patient recruitment. In particular, the determination of cTnI level and the determination of ADAMTS‐13 activity were centralized, and blood samples were systematically collected before TPE was started, which is mandatory, because this procedure may significantly impact on the measurement of these parameters . However, our study also has limitations.…”

Section: Discussionmentioning

confidence: 99%

Cardiac troponin‐I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center

Benhamou

Boëlle

Baudin

et al. 2015

Journal of Thrombosis and Haemostasis

126

105

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Summary Background Cardiac involvement is a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). However, diagnosis remains underestimated and delayed, owing to subclinical injuries. Cardiac troponin‐I measurement (cTnI) on admission could improve the early diagnosis of cardiac involvement and have prognostic value. Objectives To assess the predictive value of cTnI in patients with TTP for death or refractoriness. Patients/Methods The study involved a prospective cohort of adult TTP patients with acquired severe ADAMTS‐13 deficiency (< 10%) and included in the registry of the French Reference Center for Thrombotic Microangiopathies. Centralized cTnI measurements were performed on frozen serum on admission. Results Between January 2003 and December 2011, 133 patients with TTP (mean age, 48 ± 17 years) had available cTnI measurements on admission. Thirty‐two patients (24%) had clinical and/or electrocardiogram features. Nineteen (14.3%) had cardiac symptoms, mainly congestive heart failure and myocardial infarction. Electrocardiogram changes, mainly repolarization disorders, were present in 13 cases. An increased cTnI level (> 0.1 μg L−1) was present in 78 patients (59%), of whom 46 (59%) had no clinical cardiac involvement. The main outcomes were death (25%) and refractoriness (17%). Age (P = 0.02) and cTnI level (P = 0.002) showed the greatest impact on survival. A cTnI level of > 0.25 μg L−1 was the only independent factor in predicting death (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.13–7.22; P = 0.024) and/or refractoriness (OR 3.03; 95% CI 1.27–7.3; P = 0.01). Conclusions A CTnI level of > 0.25 μg L−1 at presentation in patients with TTP appears to be an independent factor associated with a three‐fold increase in the risk of death or refractoriness. Therefore, cTnI level should be considered as a prognostic indicator in patients diagnosed with TTP.

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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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Therapeutic Plasma Exchange Decreases Levels of Routinely Used Cardiac and Inflammatory Biomarkers

Cited by 11 publications

References 13 publications

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

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

Cardiac troponin‐I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. Experience of the French Thrombotic Microangiopathies Reference Center

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

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