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Moderator's view: High-volume plasma exchange: pro, con and consensus.

Andre A Kaplan1

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Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|October 24, 2017
PubMed
Summary

High-volume plasma exchange (HVPE) offers benefits but requires careful consideration of toxin characteristics. The optimal exchange volume depends on factors like molecular weight and toxicity of the targeted substances.

Keywords:
AKImultiple myelomaplasma exchangeplasmapheresisthrombotic microangiopathy

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Immunology

Background:

  • Plasma exchange is a critical blood purification technique.
  • High-volume plasma exchange (HVPE) is increasingly utilized for various conditions.
  • Debate exists regarding the optimal volume for therapeutic plasma exchange (TPE).

Purpose of the Study:

  • To critically evaluate the pros and cons of high-volume plasma exchange.
  • To provide a framework for selecting appropriate exchange volumes in TPE.
  • To highlight key factors influencing the efficacy of toxin removal via TPE.

Main Methods:

  • Review and synthesis of existing literature on plasma exchange volumes.
  • Analysis of arguments for and against high-volume protocols.
  • Identification of critical toxin parameters influencing removal efficiency.

Main Results:

  • Both high-volume and standard-volume plasma exchange have valid applications.
  • The choice of exchange volume is contingent upon the specific clinical scenario.
  • Key toxin characteristics significantly impact the effectiveness of TPE.

Conclusions:

  • A nuanced approach to TPE volume selection is essential.
  • Understanding toxin properties is paramount for optimizing TPE therapy.
  • Further research may refine guidelines for HVPE protocols.