Complications of double-filtration plasmapheresis

Double-filtration plasmapheresis (DFP) removes high-molecular-weight molecules semiselectively, thereby minimizing albumin loss, but with subsequent need for fluid substitution. The purpose of this study was to establish the overall incidence of complications during DFP and to analyze the possible contributory factors.

From November 1993 to October 2003, a total of 2502 plasmapheresis procedures were performed during 515 courses of plasmapheresis in 335 patients. The medical and technical records for these patients were reviewed.

The overall frequency of complications was 67.5 percent per patient, 60.0 percent per course, and 26.3 percent per procedure. The rate of major complications was 18.2 percent of patients, 13.2 percent of courses, and 2.7 percent of procedures. Hemolysis, the most common complication of DFP, occurred in 20 percent of patients. A total of 83 (3.3%) episodes of hypotension were documented in 63 patients. Vascular-access-related complications constituted approximately 17 percent of the total. There was one documented episode of clinically overt bleeding from laboratory coagulopathy necessitating infusion of fresh plasma to stop bleeding. There was no allergic reaction or mortality associated with the DFP procedures. The per-patient frequency of hypotension was higher in cases of chronic inflammatory neuropathy (35.1%) compared to the other illness categories (15.4%-17.3%), with marginal significance demonstrated (p = 0.0611).

The safety of DFP treatment has been confirmed by this study. High-risk patients should be monitored carefully during treatment to minimize the occurrence of complications.