Gashti Casey N, Andreoli Daniel C, Patel Dipal
Section of Nephrology, Department of Internal Medicine, Rush University Medical Center, 1426 West Washington BLVD, Chicago, Illinois, 60607.
J Clin Apher. 2018 Feb;33(1):38-45. doi: 10.1002/jca.21561. Epub 2017 Jun 13.
Therapeutic plasma exchange (TPE) has long been utilized to manage a variety of immune-mediated diseases. The basic principle relies on removal of circulating pathogenic substances from the bloodstream. Methods of plasma separation include centrifuge (cTPE) and membrane (mTPE). Although mTPE has existed for a few decades, recent advances in developing highly permeable filters that are compatible with currently existing dialysis machines has opened a new frontier. Published data in the area of technical and clinical experience with mTPE is lacking. We report our single center experience of 998 inpatient mTPE treatments performed in 237 patients at a large tertiary care academic center. The most common treatment indication was neurologic. We found a very low incidence of patient-reported complications. Filter clotting without the use of anticoagulation occurred in 7.7% of treatments. Laboratory parameters that significantly changed during the course of therapy included serum potassium, platelet count, and partial thromboplastin time. We found that mTPE can be safely and efficiently performed as an alternative to cTPE, and suggest an individualized approach when prescribing this therapy.
治疗性血浆置换（TPE）长期以来一直用于治疗各种免疫介导的疾病。其基本原理是从血液中清除循环中的致病物质。血浆分离方法包括离心法（cTPE）和膜分离法（mTPE）。尽管mTPE已经存在了几十年，但开发与现有透析机兼容的高渗透性滤器的最新进展开辟了一个新领域。目前缺乏关于mTPE技术和临床经验方面已发表的数据。我们报告了在一家大型三级医疗学术中心对237例患者进行998次住院mTPE治疗的单中心经验。最常见的治疗指征是神经系统疾病。我们发现患者报告的并发症发生率非常低。在7.7%的治疗中出现了未使用抗凝剂情况下的滤器凝血。治疗过程中显著变化的实验室参数包括血清钾、血小板计数和部分凝血活酶时间。我们发现mTPE作为cTPE的替代方法可以安全有效地进行，并建议在开具这种治疗处方时采用个体化方法。
