Tek Ibrahim, Arslan Onder, Arat Mutlu, Ayyildiz Erol, Tol Meltem, Oral Mehmet, Ilhan Osman
Ankara University School of Medicine, Ibni Sina Hospital, Department of Medical Oncology, Sihhiye, Ankara, Turkey.
Transfus Apher Sci. 2004 Oct;31(2):89-93. doi: 10.1016/j.transci.2004.02.010.
Apheresis is a procedure in which one of the components of blood is removed. The aim of therapeutic plasma exchange (TPE) is to remove a large fraction of the patient's plasma from the body, and to exchange this with replacement solutions using automatic devices. With this procedure circulating pathogens and toxins are reduced. Before each TPE results of a baseline basal complete blood count, serum protein electrophoresis, coagulation tests and serum electrolytes must be known. The efficacy of this therapy is assessed only by these values. The proteins responsible for disease may be monoclonal proteins, cryoglobulins, lipoproteins, auto or allo antibodies or toxins. In this study, we aimed to compare the effects of several replacement fluids on plasma viscosity and oncotic pressure. At the same time, we evaluated the correlation between plasma viscosity and oncotic pressure.
111 TPE were performed on 42 patients. Before TPE, the patients whose veins were not suitable were catheterised either by using a subclavian or jugular 11F dialysis catheter. At each session, approximately 1-1.5L of plasma was exchanged. The procedure was performed with albumin in patients whose albumin was under 3gr/dl. Over this value, the exchange fluids were randomised.
When the overall results were analysed, there was no statistically significant difference between groups 1 (HES+albumin) and group 3 (albumin). The statistical difference between group 2 and 3 was significant, but no difference was observed between group 1 and 2. According to the decreasing plasma viscosity, there was a significant difference between group 2 and group 3, but there was no difference between group 1 and group 2.
The replacement solutions used for plasmapheresis are similar when compared for hemorheologic effects, but we have chosen fresh frozen plasma because of fewer side effects.
血液分离术是一种去除血液中某一成分的操作。治疗性血浆置换（TPE）的目的是从体内去除大部分患者的血浆，并使用自动装置将其与置换液进行交换。通过该操作，循环中的病原体和毒素会减少。在每次TPE之前，必须了解基线全血细胞计数、血清蛋白电泳、凝血试验和血清电解质的结果。该疗法的疗效仅通过这些值来评估。导致疾病的蛋白质可能是单克隆蛋白、冷球蛋白、脂蛋白、自身或同种抗体或毒素。在本研究中，我们旨在比较几种置换液对血浆粘度和胶体渗透压的影响。同时，我们评估了血浆粘度与胶体渗透压之间的相关性。
对42例患者进行了111次TPE。在TPE之前，对静脉不适合的患者使用锁骨下或颈内11F透析导管进行插管。每次治疗时，交换约1-1.5L血浆。对于白蛋白低于3g/dl的患者，使用白蛋白进行该操作。超过此值时，置换液随机分配。
分析总体结果时，第1组（羟乙基淀粉+白蛋白）和第3组（白蛋白）之间无统计学显著差异。第2组和第3组之间的统计差异显著，但第1组和第2组之间未观察到差异。根据血浆粘度降低情况，第2组和第3组之间存在显著差异，但第1组和第2组之间无差异。
用于血浆置换的置换液在血液流变学效应方面相似，但由于副作用较少，我们选择了新鲜冷冻血浆。
