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Optimizing management of replacement fluids for therapeutic plasma exchange: Use of an automated mathematical model to predict post‐procedure fibrinogen and antithrombin levels in high‐risk patients
Author(s) -
Zhang Ray,
Dahl Aaron B.,
Marchant Bryan,
Jackups Ronald R.,
Karnes Hope E.,
Shah Priyank,
Dynis Marian,
Thibodeaux Suzanne R.,
Despotis George J.
Publication year - 2020
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21758
Subject(s) - fibrinogen , antithrombin , medicine , hematocrit , extracorporeal , extracorporeal circulation , albumin , adverse effect , surgery , anesthesia , cardiology , gastroenterology , heparin
Background Therapeutic plasma exchange (TPE) utilizes an extracorporeal circuit to remove pathologic proteins causing serious illness. When processing a patient's entire blood volume through an extracorporeal circuit, proteins responsible for maintaining hemostatic system homeostasis can reach critically low levels if replacement fluid types and volumes are not carefully titrated, which may increase complications. Methods The charts from 27 patients undergoing 46 TPE procedures were reviewed to evaluate the accuracy of our predictive mathematical model, utilizing the following patient information: weight, hematocrit, pre‐ and post‐TPE factor levels (fibrinogen, n = 46, and antithrombin, n = 23), process volume and volumes of fluids (eg, plasma, albumin, and normal saline) administered during TPE and adverse events during and after TPE. Results Altogether, 25% of patients experienced minor adverse events that resolved spontaneously or with management. There were no bleeding or thrombotic complications. The mean difference between predicted and measured post‐TPE fibrinogen concentrations was −0.29 mg/dL (SD ±23.0, range −59 to 37), while percent difference between measured and predicted fibrinogen concentration was 0.94% (SD ±10.8, range of −22 to 19). The mean difference between predicted and measured post‐TPE antithrombin concentrations were 0.89% activity (SD ±10.0, range −23 to 14), while mean percent difference between predicted and measured antithrombin concentrations was 3.87% (SD ±14.5, range −25 to 38). Conclusions Our model reliably predicts post‐TPE fibrinogen and antithrombin concentrations, and may help optimize patient management and attenuate complications.