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J Clin Apher. 2018 Oct;33(5):604-610. doi: 10.1002/jca.21653. Epub 2018 Sep 12.

Hemostasis management and therapeutic plasma exchange: Results of a practice survey.

Author information

1
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
2
Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky.
3
Department of Pathology and Laboratory Medicine, New York University, New York, New York.
4
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
5
Consultant, Denver, Colorado.
6
LifeSource Blood Center, Rosemont, Illinois.
7
Hematology/Oncology Division, University of Pittsburgh Medical Center Presbyterian-Shadyside Hospital, Pittsburgh, Pennsylvania.
8
Department of Laboratory Medicine, University of Washington, Seattle, Western Australia.
9
Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
10
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
11
Department of Coagulation, Quest Diagnostics Nichols Institute, Virginia.
12
Departments of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Washington, DC.
13
Bloodworks, Seattle, Western Australia.

Abstract

BACKGROUND:

Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations.

MATERIALS AND METHODS:

A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency (%) of respondents to each question.

RESULTS:

Apheresis Medicine physicians, alone (59.4%) or jointly with the requesting provider (29.2%), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7% with no history of a bleeding or clotting disorder, 1.1% with active bleeding, and 8.8% with hypofibrinogenemia (<100 mg/dL) due to recent TPE. More respondents would use albumin with or without normal saline for replacement fluid when a minor invasive procedure (49.5%) vs a major surgery (8.9%) was performed 1 day before TPE. Replacement fluid selection varied among respondents for several other clinical conditions. The most frequent use for cryoprecipitate by respondents (14.3%) was hypofibrinogenemia.

CONCLUSIONS:

These survey results demonstrate wide interinstitutional variation in replacement fluid selection to manage hemostasis in patients undergoing TPE. Further studies are needed to guide optimal hemostasis management with TPE.

KEYWORDS:

anticoagulation; apheresis; bleeding; coagulation; plasmapheresis

PMID:
30207610
DOI:
10.1002/jca.21653
[Indexed for MEDLINE]

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