Zöllner Simon, Pablik Eleonore, Druml Wilfred, Derfler Kurt, Rees Andrew, Biesenbach Peter
Internal Medicine III/Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
Blood Purif. 2014;38(2):160-6. doi: 10.1159/000367682. Epub 2014 Dec 4.
Immunoadsorption (IAS) and therapeutic plasma exchange (TPE) are considered safe although fibrinogen is removed. To date no comparison of fibrinogen reduction and associated risk of bleeding in apheresis exists.
Retrospective analysis of TPE, three IAS adsorbers, and combined TPE/IAS regarding fibrinogen reduction and bleeding incidence in 67 patients (1,032 treatments).
TPE and TPE/IAS reduced fibrinogen by 64 ± 11% and 58 ± 9%, leading to concentrations <100 mg/dl in 20 and 17% of treatments, respectively. IAS decreased fibrinogen less than TPE (26 ± 6%, p < 0.0001), resulting in fibrinogen concentrations <100 mg/dl in 1% of treatments. The processed volume correlated with reduction in TPE (r = 0.64, p < 0.01), but not in IAS. Bleeding occurred in 1.3% (IAS), 2.3% (TPE) and 3.1% (TPE/IAS) of treatments.
Hypofibrinogenemia occurs in 20% of patients after TPE and TPE/IAS, but rarely after IAS. IAS removes fibrinogen independently of volume processed. Overall, bleeding is rare in apheresis.
尽管纤维蛋白原会被清除，但免疫吸附（IAS）和治疗性血浆置换（TPE）仍被认为是安全的。迄今为止，尚无关于单采术中纤维蛋白原减少及相关出血风险的比较。
对67例患者（1032次治疗）的TPE、三种IAS吸附器以及联合TPE/IAS进行回顾性分析，观察纤维蛋白原减少情况和出血发生率。
TPE和TPE/IAS分别使纤维蛋白原降低64±11%和58±9%，分别导致20%和17%的治疗中纤维蛋白原浓度<100mg/dl。IAS使纤维蛋白原降低程度低于TPE（26±6%，p<0.0001），仅1%的治疗中纤维蛋白原浓度<100mg/dl。处理量与TPE中纤维蛋白原降低相关（r=0.64，p<0.01），但与IAS无关。治疗中出血发生率在IAS组为1.3%，TPE组为2.3%，TPE/IAS组为3.1%。
TPE和TPE/IAS后20%的患者会出现低纤维蛋白原血症，但IAS后很少出现。IAS清除纤维蛋白原与处理量无关。总体而言，单采术中出血罕见。
