Anticoagulant and membrane effects on humoral and cellular changes during plasmapheresis

Heparin (H) and citrate (C) anticoagulation with cellulose acetate (CA) and polyvinyl chloride (PVC) membrane devices were evaluated on three myasthenia gravis patients. Changes of white blood cell (WBC) and platelet (PLT) counts, complement activation, granulocyte elastase, and interleukin-1 beta (IL-1 beta) were studied sequentially. Changes in WBC and PLT counts were more dependent on the membrane material and surface area. Changes of C3a and C5a were more related to the anticoagulant used, whereas changes of C4a were membrane-material dominant phenomenon. Systemic elastase levels did not show significant differences among the groups but module outlet values were elevated for Ca + H. IL-1 beta did not show changes in all schemes. CA + H was the most activating and PVC + C was the least activating combination. Both the membrane materials and anticoagulant must be considered in evaluating humoral and blood cellular changes in plasmapheresis.