Shemin Douglas, Briggs Doris, Greenan Melanie
Division of Renal Diseases, Rhode Island Hospital, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island 02903, USA.
J Clin Apher. 2007;22(5):270-6. doi: 10.1002/jca.20143.
The type and number of complications was prospectively examined in 1,727 successive TPE treatments in 174 patients over 66 months at a single center. Most treatments were prescribed for thrombotic thrombocytopenic purpura (TTP; 42%), recurrent focal segmental glomerulosclerosis (FSGS; 22%), or myasthenia gravis (MG; 13%). About 57% of treatments used albumin-saline as the replacement solution and 43% used fresh-frozen plasma (FFP), almost all for TTP. There were 889 complications; 614 treatments (36% of the total) involved a complication. Most complications were minor; there were no deaths. Three treatments (0.2%) were discontinued due to a complication, and 2 (0.1%) required transfer to a higher acuity hospital bed. The most common complications were fever (7.7% of treatments), urticaria (7.4%), and hypocalcemic symptoms (7.3%). 42% of treatments with FFP involved a complication, compared to 30% of treatments using albumin-saline (P < 0.0001). The most common complications with FFP were urticaria (17%) and pruritus (13%); these occurred more commonly than in patients receiving albumin-saline. The most common complications with albumin-saline replacement were hypocalcemic symptoms (8.2%) and mild hypotension (8.1%). Mild and severe hypotension was significantly (P < 0.0001) more common with albumin-saline replacement. TPE is associated with a number of minor complications. Complications occur more commonly with FFP replacement compared to albumin-saline replacement. Pruritus and urticaria occur more commonly with FFP, and hypotension occurs more commonly with albumin-saline.
在一个中心，对174例患者在66个月内连续进行的1727次治疗性血浆置换（TPE）治疗的并发症类型和数量进行了前瞻性研究。大多数治疗是针对血栓性血小板减少性紫癜（TTP；42%）、复发性局灶节段性肾小球硬化（FSGS；22%）或重症肌无力（MG；13%）开出的。约57%的治疗使用白蛋白盐水作为置换液，43%使用新鲜冰冻血浆（FFP），几乎所有用于TTP。共有889例并发症；614次治疗（占总数的36%）出现了并发症。大多数并发症为轻度，无死亡病例。3次治疗（0.2%）因并发症而中断，2次治疗（0.1%）需要转至更高 acuity 的医院病床。最常见的并发症是发热（占治疗的7.7%）、荨麻疹（7.4%）和低钙血症症状（7.3%）。使用FFP的治疗中有42%出现并发症，而使用白蛋白盐水的治疗为30%（P<0.0001）。FFP最常见的并发症是荨麻疹（17%）和瘙痒（13%）；这些并发症在接受白蛋白盐水治疗的患者中更常见。白蛋白盐水置换最常见的并发症是低钙血症症状（8.2%）和轻度低血压（8.1%）。与白蛋白盐水置换相比，轻度和重度低血压在白蛋白盐水置换时明显更常见（P<0.0001）。TPE与一些轻度并发症相关。与白蛋白盐水置换相比，FFP置换时并发症更常见。FFP时瘙痒和荨麻疹更常见，白蛋白盐水时低血压更常见。
