Therapeutic plasma exchange in the treatment of thrombotic microangiopathies
Authors:
M. Lánská 1; Z. Kořístek 2; P. Žák 1
Authors‘ workplace:
IV. interní hematologická klinika LF UK a FN Hradec Králové
1; Klinika hematoonkologie LF OU a FN Ostrava
2
Published in:
Transfuze Hematol. dnes,30, 2024, No. S1, p. 7-15.
Category:
doi:
https://doi.org/10.48095/cctahd2024suppl1S7
Overview
Therapeutic plasma exchange (TPE) has an irreplaceable place in the treatment of some types of thrombotic microangiopathies. In TTP, it has become the standard of care. TPE is defined by the American Society for Apheresis (ASFA) as a therapeutic extracorporeal procedure in which the patient‘s plasma is separated from other blood components. Although it is an invasive technique requiring high-quality venous access, TPE is quite safe, and when performed correctly, complications are rare. It can be started within tens of minutes if necessary, and it has essentially no real contraindications. Separation of plasma from other blood components is ensured by centrifugation or membrane filtration. Crystalloids, 5% albumin solution and freshly frozen donor plasma are used as a replacement solution in various proportions and combinations and nowadays, solvent-detergent-treated plasma is used increasingly. At least one total plasma volume (TPV) of the patient should be replaced in one procedure, with less than 70% of the TPV being replaced. It is important to remember to collect blood samples for ADAMTS13 and other tests, or preserve plasma samples, before starting TPE treatment, as interpretation of results from samples collected after TPE may be erroneous. The efficacy of TPE is determined by two mechanisms: 1) removal of the disease mediator or plasma components contributing to the pathogenesis of the condition; 2) delivery of the missing or dysfunctional plasma component when plasma is used as a replacement solution. The efficacy of TPE varies between the various forms of thrombotic microangiopathies, ranging from a clear and prompt effect in TTP to no effect at all in some forms of atypical haemolytic uraemic syndrome.
Keywords:
thrombotic thrombocytopenic purpura – therapeutic plasma exchange – thrombotic microangiopathy – plasma
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PODÍL AUTORŮ NA RUKOPISU
ML – příprava rukopisu
ZK, PZ – korekce a revize rukopisu
PROHLÁŠENÍ AUTORŮ
Autoři práce prohlašují, že v souvislosti s tématem, vznikem a publikací tohoto článku nejsou ve střetu zájmů a vznik ani publikace článku nebyly podpořeny žádnou farmaceutickou firmou.
Do redakce doručeno dne: 6. 12. 2023.
Přijato po recenzi dne: 20. 5. 2024.
MUDr. Miriam Lánská, Ph.D.
IV. interní hematologická klinika
FN Hradec Králové
Sokolská 581
e-mail: miriam.lanska@fnhk.cz
Labels
Haematology Internal medicine Clinical oncologyArticle was published in
Transfusion and Haematology Today
2024 Issue S1
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- Atypical haemolytic uremic syndrome
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- Therapeutic plasma exchange in the treatment of thrombotic microangiopathies