Vatazin A V, Zulkarnaev A B
M.F. Vladimirskiy Moscow Regional Research and Clinical Institute, Moscow, Russia.
Ter Arkh. 2018 Jun 20;90(6):22-27. doi: 10.26442/terarkh201890622-27.
To investigate the impact of double filtration plasmapheresis (DFPP) and therapeutic plasma exchange (TPE) on hemostasis in renal transplant recipients.
54 renal transplant patients with an acute humoral rejection were treated with therapeutic apheresis methods: 24 patients with DFPP and 30 patients with TPE. In all patients was performed 3-4 session. We analyzed international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen concentration and platelet count just before and after each session, and after the course of all procedures. After TPE plasma replacement was performed with an equivalent volume of a fresh frozen plasma. After DFPP was performed 10-20% albumin solution.
After each DFPP session was occurred an increased INR and aPTT. After course of all DFPP procedures fibrinogen level decreased by 46%. It was associated with increase of APTT and INR by 35% and 32% respectively. Mainly it was associated with dose of the procedures (volume of plasma perfusion), but not with the plasma separator type. One patient noted hemorrhagic complication. After each TPE session level of fibrinogen concentration, INR and aPPT remained in the normal range, but there was a moderate reduction in platelet count, more pronounced than during DFPP. Hemorrhagic complications were not.
Double cascade plasmapheresis and therapeutic plasma exchange generate preconditions for hemorrhagic complications such as increased aPTT and INR, reduce fibrinogen concentration. However, bleeding complications are rare. At the same time, during high volume DFPP should be careful when initially level of fibrinogen is low. In this case fibrinogen concentration should be controlled after the procedure for timely replenishment of its deficit.
探讨双重过滤血浆置换（DFPP）和治疗性血浆置换（TPE）对肾移植受者止血功能的影响。
54例急性体液排斥反应的肾移植患者接受治疗性血液分离术：24例采用DFPP，30例采用TPE。所有患者均进行3 - 4次治疗。我们分析了每次治疗前、治疗后以及整个疗程结束后国际标准化比值（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原浓度和血小板计数。TPE后用等量新鲜冰冻血浆进行血浆置换。DFPP后用10 - 20%白蛋白溶液。
每次DFPP治疗后INR和APTT升高。所有DFPP治疗疗程结束后，纤维蛋白原水平下降46%。这分别与APTT和INR升高35%和32%相关。主要与治疗剂量（血浆灌注量）有关，而与血浆分离器类型无关。1例患者出现出血并发症。每次TPE治疗后纤维蛋白原浓度、INR和aPPT水平仍在正常范围内，但血小板计数有中度下降，比DFPP期间更明显。未出现出血并发症。
双重级联血浆置换和治疗性血浆置换会引发出血并发症的前提条件，如APTT和INR升高、纤维蛋白原浓度降低。然而，出血并发症很少见。同时，在高容量DFPP治疗时，若初始纤维蛋白原水平较低应谨慎。在这种情况下，治疗后应监测纤维蛋白原浓度，及时补充其不足。
