von Heymann Christian, Lier Heiko, Rosenthal Christoph, Kaufner Lutz
Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
Faculty of Medicine and University Hospital Cologne, Clinic for Anesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.
Transfus Med Hemother. 2022 Dec 14;50(2):107-115. doi: 10.1159/000528136. eCollection 2023 Apr.
Different preparations for therapeutic plasma are available on the market. The German hemotherapy guideline has been completely updated in 2020 and, for this purpose, has reviewed the evidence for the most frequent clinical indications for the use of therapeutic plasma in adult patients.
The German hemotherapy guideline has reviewed the evidence for the following indications for the use of therapeutic plasma in the adult patient: massive transfusion and bleeding, severe chronic liver disease, disseminated intravascular coagulation, plasma exchange for TTP, and the rare hereditary FV and FXI deficiencies. The updated recommendations for each indication are discussed on the background of existing guidelines and new evidence. For most indications, the quality of evidence is low due to missing prospective randomized trials or rare diseases. However, due to the "balanced" content of coagulation factors and inhibitors therapeutic plasma remains an important pharmacological treatment option in clinical situations with an already activated coagulation system. Unfortunately, the "physiological" content of coagulation factors and inhibitors limits the efficacy in clinical scenarios with high blood losses.
The evidence for the use of therapeutic plasma for the replacement of coagulation factors due to massive bleeding is poor. Coagulation factor concentrates seem to be more appropriate for this indication, although the quality of evidence is also low. However, for diseases with an activated coagulation or endothelial system (e.g., disseminated intravascular coagulation, TTP) the balanced replacement of coagulation factors, inhibitors, and proteases may be of advantage.
市场上有不同的治疗性血浆制剂。德国血液治疗指南于2020年进行了全面更新，为此审查了成人患者使用治疗性血浆最常见临床适应症的证据。
德国血液治疗指南审查了成人患者使用治疗性血浆的以下适应症的证据：大量输血和出血、严重慢性肝病、弥散性血管内凝血、用于血栓性血小板减少性紫癜的血浆置换，以及罕见的遗传性FV和FXI缺乏症。在现有指南和新证据的背景下讨论了每种适应症的更新建议。由于缺乏前瞻性随机试验或疾病罕见，大多数适应症的证据质量较低。然而，由于凝血因子和抑制剂的“平衡”含量，治疗性血浆在凝血系统已经激活的临床情况下仍然是一种重要的药物治疗选择。不幸的是，凝血因子和抑制剂的“生理”含量限制了在大量失血临床场景中的疗效。
因大量出血而使用治疗性血浆替代凝血因子的证据不足。凝血因子浓缩物似乎更适合这一适应症，尽管证据质量也较低。然而，对于凝血或内皮系统激活的疾病（如弥散性血管内凝血、血栓性血小板减少性紫癜），凝血因子、抑制剂和蛋白酶的平衡替代可能具有优势。
