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Bleeding Risk Is Not Increased When Initiating Therapeutic Plasma Exchange in Adults Using Exclusively Albumin
Jay S Raval1,2, Marian A Rollins-Raval1,2, Yara A Park1
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
Journal of Clinical Apheresis
|April 20, 2026
Summary
For patients undergoing therapeutic plasma exchange (TPE) after kidney biopsy, using albumin or albumin-and-plasma replacement fluid showed identical bleeding risks when TPE started two days post-biopsy. Future research should focus on the first day after biopsy for bleeding risk assessment.
Area of Science:
- Nephrology
- Hematology
- Medical Procedures
Background:
- Therapeutic plasma exchange (TPE) is used after percutaneous kidney biopsy.
- Replacement fluid selection for TPE post-kidney biopsy varies among centers.
- Plasma is frequently used as part of the replacement fluid for TPE.
Purpose of the Study:
- To compare bleeding risk at the kidney biopsy site between patients receiving TPE with albumin-only versus albumin-and-plasma replacement fluid.
- To evaluate the impact of replacement fluid composition on bleeding complications after percutaneous kidney biopsy when TPE is initiated two days post-procedure.
Main Methods:
- Retrospective analysis of 100 consecutive patients undergoing percutaneous kidney biopsy followed by TPE initiated two days later.
- Patients were divided into two cohorts: one receiving exclusively albumin replacement fluid, the other receiving both albumin and plasma replacement fluid.
- Bleeding rates at the kidney biopsy site were compared between the two groups.
Main Results:
- The rate of bleeding at the kidney biopsy site was identical in both cohorts.
- One patient (2%) in the albumin-only group experienced bleeding.
- One patient (2%) in the albumin-and-plasma group experienced bleeding.
Conclusions:
- Albumin-only replacement fluid is as safe as albumin-and-plasma replacement fluid regarding bleeding risk when TPE is initiated two days after percutaneous kidney biopsy.
- Future studies investigating bleeding risk should focus on the immediate period within one day after percutaneous kidney biopsy.
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