RESUMEN
Plasma exchange therapy is applied for treatment of severe immune diseases of multiple organ systems and severe liver diseases by removing pathogenic factors and regulating immune function. Regional citrate anticoagulation has no effect on systemic coagulation function and does not increase bleeding risk, and it is one of the optional anticoagulation methods for plasma exchange therapy. This article reviews recent literature on simple plasma exchange therapy with regional citrate anticoagulation to provide a reference for clinical application of this therapy.
RESUMEN
BACKGROUND: Therapeutic plasma exchange (TPE) removes pathogenic substances through a centrifugation or membrane filtration method. During the procedure for TPE, normal substances can be reduced with the removal of such pathogens. We evaluated a simple plasma exchange (SPE) and a modified technique called post-centrifugal plasma filtration (PCPF), and analyzed the degree of changes in substances between the two methods. METHODS: 14 chemical or serologic tests were performed on 129 samples from 16 patients and medical records were reviewed. Samples were divided into pre and post-apheresis measurements and delta values of pre and post-apheresis measurements were attained and compared for any statistical differences in the two methods. RESULTS: All post-apheresis concentrations were decreased compared to pre-apheresis levels in both methods. Two items revealed a statistical difference between the two methods. The IgG and rheumatoid factor, composed mainly of IgM, were reduced significantly in the SPE compared to the PCPF group (P=0.0009 P=0.02, respectively). CONCLUSIONS: Many factors, such as the size of the membrane pores and the patient's individual diagnosis played a very important role in the overall outcome of plasmapheresis. Although our study revealed a significant decrease in the IgG and RF in the SPE group, compared to the PCPF group, no other significance could be stated in the other substances measured. Therefore, such multivariable factors should be considered in the selection of the apheresis method.