Sanford Kimberly W, Balogun Rasheed A
Department of Pathology, Virginia Commonwealth University, Richmond, Virginia 23298-0662, USA.
J Clin Apher. 2011;26(5):249-51. doi: 10.1002/jca.20304. Epub 2011 Aug 10.
Therapeutic apheresis procedures in critically ill patients comprises of therapeutic plasma exchange in most cases but also less commonly, erythrocytapheresis (red cell exchange), thrombocytapheresis, or leukocytapheresis. These procedures present a number of challenges to the apheresis healthcare team, and there are myriad beneficial and adverse effects for patients. In this patient population, one has to weigh the risks against the benefits and especially in those situations where apheresis is requested as a treatment when other alternative therapies have failed. Therapeutic plasma exchange is capable of removing toxins, pathologic auto- and allo-antibodies but will also remove beneficial medications, clotting factors and cations which are chelated by citrate anticoagulant. Herein, we review clinically significant issues that are commonly encountered in patients that are in the intensive care unit and have conditions that require therapeutic apheresis.
重症患者的治疗性血液分离术在大多数情况下包括治疗性血浆置换，但较少见的还有红细胞单采术（红细胞置换）、血小板单采术或白细胞单采术。这些操作给血液分离术医护团队带来了诸多挑战，对患者也有无数有益和不良影响。在这类患者群体中，必须权衡风险与益处，尤其是在其他替代疗法失败而要求进行血液分离术作为治疗手段的情况下。治疗性血浆置换能够清除毒素、病理性自身抗体和同种抗体，但也会清除有益药物、凝血因子以及被枸橼酸盐抗凝剂螯合的阳离子。在此，我们回顾重症监护病房中需要进行治疗性血液分离术的患者常见的具有临床意义的问题。
