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Coagulation abnormalities in serial double-filtration plasmapheresis
Abstract:
Intensive plasma exchange can transiently alter the hemostatic system. However, the effect of serial double filtration plasmapheresis (DFP) on the hemostatic system has not been adequately described. In this study, we sought to characterize the hemostatic effects of DFP in 32 myasthenia gravis patients who received one course of DFP treatment for five consecutive sessions within 10 days. Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and serum levels of albumin, globulin, cholesterol, and fibrinogen were measured before and after the course of DFP. Patients were divided into mild hypofibrinogenemia (MH) and severe hypofibrinogenemia (SH) groups based on post-plasmapheresis residual levels of fibrinogen above or below 70 mg/dl. The baseline fibrinogen level was significantly lower in the SH group (P < 0.01). After five sessions of DFP, the fibrinogen level was reduced to below 70 mg/dl in 14 patients (44%). The percentage of excessive prolongation of PT or PTT was significantly higher in the SH group. The SH group also had higher reduction rates of globulin and cholesterol (P < 0.05). Oozing in the punctured site of the central venous catheter occurred in 6 out of 26 patients, with four cases in the MH group and two in the SH group. There was no difference in the overall incidence of bleeding complications between the two groups. Only one episode of clinically overt bleeding occurred during the study after a large-bore femoral catheter was removed soon after the patient had received five consecutive daily treatments. The bleeding stopped after transfusion of 6 units of fresh frozen plasma. In conclusion, despite the obvious reduction of fibrinogen level and the modest decrease in platelet count after an intensive course of DFP treatment, the low incidence of clinically overt bleeding confirmed the safety of DFP.
Insights
Serial double filtration plasmapheresis (DFP) significantly reduces fibrinogen levels in myasthenia gravis patients. Despite hemostatic alterations, DFP demonstrates safety with a low incidence of bleeding complications.
Area of Science:
- Hematology
- Neurology
- Nephrology
Background:
- Plasma exchange therapies can impact the hemostatic system.
- The specific effects of serial double filtration plasmapheresis (DFP) on hemostasis require further elucidation.
Purpose of the Study:
- To characterize the hemostatic effects of a 10-day course of serial DFP in myasthenia gravis patients.
- To assess the safety and bleeding complications associated with intensive DFP treatment.
Main Methods:
- Thirty-two myasthenia gravis patients underwent five consecutive DFP sessions over 10 days.
- Hemostatic parameters (platelet count, PT, PTT) and serum analytes (albumin, globulin, cholesterol, fibrinogen) were measured pre- and post-treatment.
- Patients were stratified into mild hypofibrinogenemia (MH) and severe hypofibrinogenemia (SH) groups based on post-DFP fibrinogen levels.
Main Results:
- DFP treatment reduced fibrinogen levels below 70 mg/dl in 44% of patients.
- The SH group exhibited a higher incidence of prolonged PT/PTT and greater reductions in globulin and cholesterol.
- Minor oozing at catheter sites occurred in 23% of patients, with no significant difference in bleeding complications between MH and SH groups.
Conclusions:
- Intensive serial DFP significantly lowers fibrinogen levels and affects other hemostatic parameters.
- Despite these changes, DFP treatment is associated with a low incidence of clinically significant bleeding, confirming its safety profile in myasthenia gravis patients.