Department of Medicine, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA.
J Clin Apher. 2022 Jun;37(3):292-312. doi: 10.1002/jca.21973. Epub 2022 Feb 23.
Therapeutic plasma exchange (TPE) alters the hemostatic balance. Contributing to TPE's hemostatic effects is the mechanical processing of blood in the extracorporeal circuit, circuit anticoagulant, type of replacement fluid, TPE schedule and number of procedures, TPE timing relative to invasive procedures, and removal of nontargeted components such as platelets, coagulation proteins, and cytokines. Although TPE's hemostatic effects are well established, how it impacts the bleeding risk is not clearly understood. In this concise review, we describe the effects of the above TPE-related factors on hemostatic balance, present data on the effects of TPE on blood hemostasis, including its effects on platelet counts and clotting assays, and review the literature on the impact of TPE-induced hemostatic changes on TPE-associated bleeding events. Finally, we discuss risk factors associated with bleeding during TPE and review the literature on TPE-associated hemostatic effects in the pediatric population.
治疗性血浆置换 (TPE) 会改变止血平衡。导致 TPE 产生止血作用的因素包括体外回路中的血液机械处理、回路抗凝剂、替代液类型、TPE 方案和治疗次数、TPE 相对于有创操作的时机以及去除非靶向成分，如血小板、凝血蛋白和细胞因子。尽管 TPE 的止血作用已得到充分证实，但它如何影响出血风险尚不清楚。在这篇简明的综述中，我们描述了上述与 TPE 相关的因素对止血平衡的影响，介绍了 TPE 对血液止血的影响的数据，包括其对血小板计数和凝血检测的影响，并回顾了 TPE 诱导的止血变化对 TPE 相关出血事件的影响的文献。最后，我们讨论了 TPE 过程中出血的相关风险因素，并回顾了关于儿科人群 TPE 相关止血作用的文献。
