TY - JOUR ID - TI - Small Volume Therapeutic Plasma Exchange Using Crystalloid Replacement Fluid is the Choice in Patients with Concomitant Anemia AU - Zainab Mohammed Hasan AU - Abbas Hashim Abdulsalam PY - 2011 VL - 1 IS - 1 SP - 50 EP - 56 JO - Iraq Joural of Hematology المجلة العراقية لامراض الدم SN - 20728069 25432702 AB - AbstractBackground: Therapeutic plasma exchange (TPE) is used to treat a variety of diseases, however, patient who needssuch therapeutic regime can be already anemic and TPE itself may worsen the state of anemia by imposingred cell hemolysis and dilution.Objectives: To evaluate the effect of small volume TPE, type of replacement fluid, frequency of sessions and totalvolume of plasma exchanged on the level of Hb concentration and PCV %.Patients & Methods: This is a prospective study in which 50 patients underwent TPE at National Center for BloodTransfusion. A course of 3-12 TPE sessions performed at 1-11 days intervals; in each session about 1 liter ofplasma was exchanged. Normal saline used as the replacement fluid for 25 patients and diluted FFP used forremainder.Results: Hb concentration and PCV % changed significantly after the first (P-value 0.003 and 0.03 respectively) andlast (P-value 0.001 for both) TPE sessions using crystalloid replacement fluid. Also Hb concentration andPCV % changed significantly after the first (P-value 0.006 and <0.001 respectively) and last (P-value <0.001for both) TPE sessions using diluted FFP fluid. The differences in Hb concentration and PCV % were notrelated to the type and total amount of replacement fluid, frequency and spacing between sessions. Alsothere was no relation between the frequency of complications and type of replacement fluid and amount ofplasma exchanged per session except for perioral numbness and bleeding from site of puncture in which itwas significant with p-value 0.01 and 0.001 respectively.Conclusions: Crystalloid solution can be used as the replacement fluid in small volume TPE especially in anemicpatients. The amount of PE per session is a limiting factor for the development of TPE-related bleeding.Increasing the frequency of TPE sessions and reducing time spacing between them to increase the totalamount of PE is safe. TPE-related citrate toxicity is reduced by using crystalloid replacement fluid.

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