Atrial natriuretic peptide serum concentration decreases in donors undergoing discontinuous plasmapheresis involving a large extracorporeal blood volume

Abstract

In donor plasmapheresis, circulatory reactions occur at a similar frequency as in whole-blood donation although the large extracorporeal blood volume (ECV) occurring during discontinuous plasmapheresis might predispose donors to hypovolemic reactions. The regulatory mechanisms compensating for this intradonation blood volume (BV) deficit are not well understood. It was the aim of this study to delineate whether atrial natriuretic peptide (ANP) is involved in the BV regulation of plasmapheresis donors. Because ANP regulates volume overload, it might decrease during BV decrease in plasmapheresis. ANP serum concentrations were determined in 60 donors undergoing discontinuous plasmapheresis. Samples were taken before the start of the procedure and when maximum ECV (ECV(max)) was reached at the end of the last withdrawal. Donors were randomly selected after stratification for sex and BV. In a control investigation, the same donors were kept in a reclined position for the duration of a plasmapheresis session without plasma withdrawal. ANP plasma concentration changes were correlated with changes of hemodynamic variables, which were recorded noninvasively with bioelectrical impedance cardiography. Median ANP concentration decreased from 13.0 to 8.4 pg per mL during donation and from 11.6 to 10.5 pg per mL during the control session. The mean control-adjusted ANP change due to plasma withdrawal was -2.62 pg per mL (p = 0.006). This decrease was not attributable to a dilution effect. ANP change did not correlate with changes of recorded hemodynamic variables. The decrease of the ANP serum concentration during plasmapheresis demonstrates that the ECV(max) constitutes a hypovolemic challenge of the donors, which elicits a neurohormonal regulatory mechanism aimed at maintaining cardiovascular homeostasis.