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Vancomycin removal during a plasma exchange transfusion.

M A Foral¹, S M Heineman

¹Algent Health Bergan Mercy Medical Center, School of Pharmacy and Allied Health Professions, Creighton University, Omaha, NE 68178-0401, USA. prforal@creighton.edu

The Annals of Pharmacotherapy

|November 29, 2001

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Plasma exchange transfusions can significantly remove vancomycin, potentially leading to subtherapeutic levels in patients with sickle-cell disease. Close monitoring of vancomycin concentrations is crucial during these treatments.

Area of Science:

Pharmacology
Hematology
Nephrology

Background:

Vancomycin is a critical antibiotic for treating serious infections, especially in immunocompromised patients.
Sickle-cell disease (SCD) patients often require intensive treatments, including blood product transfusions and antibiotics.
Plasma exchange (PE) is a therapeutic apheresis technique used in various hematologic and systemic conditions.

Observation:

A case study involving a 46-year-old African American woman with SCD who received vancomycin treatment on three separate occasions.
Vancomycin serum drug concentrations were monitored, revealing significantly lower levels than predicted during one admission when PE was performed concurrently.
Bayesian pharmacokinetic modeling was employed to interpret the observed vancomycin concentrations.

Findings:

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Plasma exchange transfusion was associated with clinically significant removal of vancomycin from the plasma.
Concurrent PE and vancomycin therapy can lead to potentially subtherapeutic vancomycin concentrations.
This removal effect may result in inadequate dosing and treatment failure if not addressed.

Implications:

Patients undergoing frequent plasma exchange may be at risk of vancomycin underdosing.
Vigilant and frequent monitoring of vancomycin serum concentrations is recommended for patients receiving concurrent PE.
Further research is warranted to establish optimal vancomycin dosing strategies and monitoring protocols in this patient population.