Partial plasma protein replacement in therapeutic plasma exchange.

Area of Science:

• Clinical Medicine
• Biochemistry
• Immunology

Background:

• Plasma exchange (PE) is a therapeutic apheresis procedure that removes plasma.
• Hypovolemia and hypoproteinemia are potential complications of PE due to significant protein loss.
• Maintaining adequate protein levels is crucial for patient stability during and after PE.

Purpose of the Study:

• To evaluate the efficacy of subtotal protein replacement in preventing hypovolemia and hypoproteinemia during PE.
• To determine if partial albumin replacement is sufficient to counteract protein deficits caused by PE.

Main Methods:

• Seven well-nourished outpatients with multiple sclerosis underwent 60 PE sessions.
• Each session involved removing 2 liters of plasma and replacing it with 750 ml saline and 1250 ml of 5% albumin solution (62.5% albumin replacement).
• Serum total protein, protein electrophoresis, and immunoglobulin levels were measured pre- and post-exchange.

Main Results:

• PE procedures were clinically well tolerated.
• Mean total serum protein decreased by only 18% during the study.
• Mean pre-exchange serum albumin levels remained unchanged, despite a 57-72% decrease in immunoglobulins.

Conclusions:

• Partial albumin replacement (62.5%) is adequate to prevent hypovolemia and hypoproteinemia in well-nourished patients undergoing PE.
• This level of albumin replacement effectively substitutes for the protein removed during PE.
• The findings support the use of partial albumin replacement in PE protocols for selected patients.