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Efficacy of membrane filtration, influence on hemostasis, immunoglobulins and inflammation mediators during daily
Abstract:
Plasma exchange (PE) by membrane filtration was performed with the following hollow fibers: cellulose-diacetate (Plasmaflo 01, Plasmaflo 02, Asahi, Japan), polypropylene (Plasmaflux, Fresenius, FRG) and polymethylmethacrylate (Plasmax, Toray, Japan). The elimination-coefficient (EC) for certain plasma proteins was calculated. With all hollow fibers no correlation between the EC for about ten plasma proteins with a molecular weight of 54.000 dalton up to 2.400.000 dalton. The mean EC-values for the fibers studied were: 0.32 (Plasmaflo 01), 0.52 (Plasmaflo 02), 0.52 (Plasmaflux) and 0.58 (Plasmax). Membrane filtration performed with the single needle technique using either Plasmaflo 02 or Plasmaflux resulted in a significantly lower efficiency with mean EC-values of 0.33 and 0.32 respectively. After three or four days of PE treatment using three liters of 3% human albumin solution as replacement fluid several alterations in parameters of hemostasis were altered: Antithrombin III levels dropped to 35% of normal value after each plasma exchange but increased to normal range within 24 hours during the observed period of four consecutive PE, Fibrinogen concentration dropped permanently to a preexchange value of 40% of the initial concentration after three plasma exchanges. A 40-50% decrease was also observed for prothrombin, plasminogen and alpha-2-macroglobulin after plasma exchange. A decrease in the platelet count ranging from 5 to 25% after each plasma exchange was observed but returned to the initial level before the next treatment. The concentrations of IgG IgA and IgM decreased to less than 20% of preexchange values and C 3 and C 4 to 20-30: of preexchange values after three plasma exchanges.(ABSTRACT TRUNCATED AT 250 WORDS)