Shunkwiler Sara M, Pham Huy P, Wool Geoffrey, Ipe Tina S, Fang Deanna C, Biller Elizabeth, Treml Angela, Weiss John, Baron Beverly W, Berg Mary
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
J Clin Apher. 2018 Jun;33(3):371-379. doi: 10.1002/jca.21592. Epub 2017 Oct 26.
We surveyed multiple apheresis centers represented by the authors for their clinical approach to the management of anticoagulation issues during therapeutic plasma exchange (TPE). We present the results of their practices and a review of the pertinent literature. As plasma is removed during TPE, replacement with all or partial non-plasma-containing fluids (eg, 5% albumin) may lead to significant changes in hemostasis. These changes are amplified in patients who are receiving anticoagulation. We discuss various anticoagulants as well as the monitoring and adjustment of anticoagulation before, during, and after TPE. No single guideline can be applied, but rather, patients must be monitored individually, taking into account their often complex clinical conditions and medication profiles.
我们调查了由作者代表的多个单采中心在治疗性血浆置换（TPE）期间处理抗凝问题的临床方法。我们展示了他们的实践结果并对相关文献进行了综述。由于在TPE过程中血浆被去除，用全部或部分不含血浆的液体（如5%白蛋白）替代可能会导致止血方面的显著变化。这些变化在接受抗凝治疗的患者中会被放大。我们讨论了各种抗凝剂以及TPE前、中、后的抗凝监测和调整。没有单一的指南可以适用，相反，必须根据患者通常复杂的临床状况和用药情况对其进行个体化监测。
