The Rationale for Therapeutic Plasma Exchange

The Rationale for Therapeutic Plasma Exchange Stuart L. Goldstein, MD Professor of Pediatrics Baylor College of Medicine Medical Director, Renal Dialysis and Pheresis Service Texas Children’s Hospital Houston, Texas

Outline • Principles of TPE – Centrifugal TPE – Membrane TPE

• What rationale exists for TPE? – When should TPE be considered – AABB, ASFA classifications

• Specific disease entities

Membrane vs. Centrifugation • In the US, most TPE is performed by centrifugation.  One machine can do all apheresis procedures. • Double filtration method: first membrane separates plasma from cellular portion and second membrane separates globulin from albumin.

Blood Components Separated by Centrifugation

Platelets

Plasma

Lymphocytes Monocytes Granulocytes

Neocytes Erythrocytes

Plasma Exchange

TPE: Available techniques techniques... • Cascade or secondary filtration: Separated blood is perfused through a plasma filter (1) to remove certain plasma elements. The second column (2) (cascade) absorbs the element and the plasma is returned to the patient. 1

2

PATIENT

Plasma removal is affected by: • Qb • Hct • Pore Size • TMP =Plasma effluent

Qb 100-150 Hct 25-45%

Pore Size

TMP 1, oliguria)

• ULVWF seen in 15/25 patients with decreased ADAMTS-13 activity and TAMOF (technique?) • All four pts with activity