Hemostasis Laboratory, CHU Grenoble-Alpes, Grenoble, France.
Therex, TIMC-IMAG, CNRS UMR5525, Grenoble-Alpes, Grenoble, France.
J Clin Apher. 2021 Jun;36(3):408-419. doi: 10.1002/jca.21879. Epub 2021 Jan 28.
Plasmapheresis can deplete pathogenic antibodies and allow ABO- and/or HLA-incompatible transplantation.
To determine the impacts of three modalities of plasmapheresis (centrifugal plasmapheresis [cTPE], single-filtration plasmapheresis [mTPE], double-filtration plasmapheresis [DFPP]) on hemostasis parameters and thrombin generation.
MATERIALS/METHODS: Prospective, comparative study on 21 patients that received three modalities of plasmapheresis (7 patients/group). Hemostasis (prothrombin time [PT], activated partial thromboplastin time [aPTT], procoagulant factors and natural anticoagulants) were measured before and after the first plasmapheresis session. Thrombin generation was also assessed in platelet-poor plasma using an STA-Genesia (Stago) analyzer and Thromboscreen reagents (Stago) in 4-5 patients from each group.
Both cTPE and mTPE resulted in high decreases in proteins, whatever their molecular weights. Median post/pre ratios were 0.27 to 0.55 for cTPE for most proteins (except FVIII [0.64] and VWF [0.57]). Median post/pre-ratios of mTPE were 0.28 to 0.56 for all proteins. DFPP decreased high-molecular-weight proteins (fibrinogen, FV, FVIII, FXI, VWF) and proteins strongly bound to large molecules (protein SandTFPI). Median post/pre ratios with cTPE and mTPE were similar to DFPP for fibrinogen and FXIII. Regarding thrombin generation, cTPE and mTPE did not significantly modify endogenous thrombin potential (ETP) and DFPP induced a slight decrease in ETP (median post/pre ratio at 0.73) in the absence of thrombomodulin. ETP inhibition by thrombomodulin was decreased for all procedures.
DFPP depleted high molecular-weight proteins in contrast to cTPE and mTPE, which significantly decreased all proteins. Regarding thrombin generation, depletion of procoagulant factors was counterbalanced by a decrease in some natural anticoagulants whatever plasmapheresis method used; with all methods, fibrinogen and FXIII were highly depleted.
血浆置换可以清除致病抗体，并允许进行 ABO 和/或 HLA 不相容的移植。
确定三种血浆置换方式（离心式血浆置换[cTPE]、单次滤过式血浆置换[mTPE]、双滤过式血浆置换[DFPP]）对止血参数和凝血酶生成的影响。
材料/方法：前瞻性、比较研究纳入 21 名接受三种血浆置换方式（每组 7 名患者）的患者。在首次血浆置换前后测量止血（凝血酶原时间[PT]、活化部分凝血活酶时间[aPTT]、促凝因子和天然抗凝剂）参数。使用 STA-Genesia（Stago）分析仪和 Thromboscreen 试剂（Stago）在每组 4-5 名患者的血小板减少血浆中评估凝血酶生成。
cTPE 和 mTPE 均导致蛋白质大量减少，无论其分子量如何。cTPE 对大多数蛋白质（除了 FVIII[0.64]和 VWF[0.57]）的中值治疗后/治疗前比值为 0.27 至 0.55。mTPE 的所有蛋白质的中值治疗后/治疗前比值为 0.28 至 0.56。DFPP 减少了高分子量蛋白质（纤维蛋白原、FV、VIII、XI、VWF）和与大分子紧密结合的蛋白质（蛋白 S 和 TFPI）。cTPE 和 mTPE 的纤维蛋白原和 FXIII 治疗后/治疗前比值与 DFPP 相似。关于凝血酶生成，cTPE 和 mTPE 没有显著改变内源性凝血酶潜能（ETP），DFPP 在没有血栓调节蛋白的情况下轻微降低 ETP（治疗后/治疗前比值为 0.73）。所有程序的血栓调节蛋白抑制的 ETP 均降低。
DFPP 耗尽了高分子量蛋白质，而 cTPE 和 mTPE 则显著降低了所有蛋白质。关于凝血酶生成，无论使用哪种血浆置换方法，促凝因子的耗竭都被一些天然抗凝剂的减少所平衡；所有方法均高度消耗纤维蛋白原和 FXIII。
