Use Of Replacement Fluid Research Articles

MO079SECURITY OF THERAPEUTIC APHERESIS IN PEDIATRICS. PROSPECTIVE STUDY DURING 2018 IN 171 APHERESIS SESSSIONS

Abstract Background and Aims Identify hypocalcemia and hemodynamic disorders related to apheresis in pediatrics either complications in vascular access or related to anticoagulation and adverse reactions with replacement fluid. Method Prospective and descriptive study of 171 sessions for therapeutic apheresis in pediatrics during 2018. Inclusion criteria was based on the 2016 Clinical-Practice-of-Therapeutic-Apheresis-guidelines(ASFA). The apheresis technique was selected also based on the 2016 ASFA Guidelines and the expertise in our center. Results The 171 sessions were distributed as follows: 73% were immunoadsorption(IA), 12% were cytoapheresis, 10.5% were LDL-apheresis and 4.5% therapeutic plasma exchange(TPE). The average age was 9 years and 58% were women. 50, 33 and 17% were due to Nephrological, Neurological and Digestive pathology respectively. 83% of the nephrological indications correspond to a category I of the ASFA Guidelines, as well as 25% of the neurological indications and all indications of Digestive pathology correspond to a category II. 58, 25 and 17% used temporary catheter, permanent catheter and needles respectively. Only one patient is accidentally removed from the temporary jugular catheter and it has not been related to vascular access or by the apheresis technique itself. Sixty-six percent had individual anticoagulation with citrate/calcium plus heparin and the remaining 33%, only once. Any case of bleeding related to catheter or others. Only 3 sessions of IA in the hypocalcemia objective, being symptomatic in only one of them. Of all 8 sessions of TPE, we performed 6 with frozen fresh plasma as replacement fluid with no adverse reactions. Conclusion The apheresis techniques in pediatrics had been presented with few complications in our center, none derived from vascular access, anticoagulation, infections or adverse effects due to use of replacement fluid. The training of medical and nursing staff is essential to identify risk situations. The use of protocols and international guidelines ensure safety in pediatrics.

The role of plasma exchange in hyperbilirubinemia from a different perspective

Objective: In this retrospective study, we aimed to present our experience of managing hyperbilirubinemia. Method: Twenty three patients with hyperbilirubinemia who received apharesis treatment between 2006 and 2017 at the apheresis unit of Cumhuriyet University School of Medicine were included in the study. Records of the patients were evaluated retrospectively and the following data were collected: patient’s age, sex, presenting symptoms, number of plasma exchange, adjuvant treatment modalities, use of replacement fluid, treatment outcomes, and plasma exchange complications . Results: The median age of the patients was 57 years (range; 18-82). The median number of plasma exchange was 5,5 (range; 1-25). Fresh frozen plasma was the only replacement fluid used. There was significant statistical differences between pre- and post-plasma exchange bilirubine levels (p<0.05). Toxic hepatitis was the most common cause of hyperbilirubinemia in our patient population. In addition to plasma exchange, patients were treated with proper treatment of the underlying condition. We observed allergic reactions 2 (8.69%) patients and hypotension in 3 (13%) patients as complications Conclusions: Plasma exchange is a safe method for the elimination of bilirubin. However, diminishing hyperbilirubinemia with plasma exchange together with the proper treatment of the underlying condition should be the primary goal in management.

Plasmapheresis for neuroinflammatory disorders

AbstractNowadays, therapeutic plasma exchange (PE) is the most common apheresis procedure. Plasma is separated from corpuscular blood constitutents and replaced with a substitution fluid. Thus, PE is a non‐specific treatment modality. Its therapeutic effect is based on the removal of circulating, pathogenic immune factors, including autoantibodies. To date, PE is well established for several immune mediated neurological disorders. Whilst the first experience was acquired in acute life‐threatening conditions, such as the treatment of Guillain–Barré syndrome or myasthenic crisis, therapeutic success was later achieved in other chronic autoimmune diseases; PE was applied successfully in chronic inflammatory demyelinating polyneuropathy, paraproteinaemic polyneuropathy, stiff‐person syndrome and might also be tried in autoimmune diseases of paraneoplastic origin. From a novel aspect, PE was also established as an escalation therapy for steroid unresponsive relapses of multiple sclerosis, and thus has gained even more widespread attention. Humoral disease mechanisms dominate even more in neuromyelitis optica, as a subtype of MS, and usually respond to PE. Adding to its increasing application in clinical practice, the procedure is usually well tolerated. Possible adverse reactions of PE arise from the large‐size vascular access site, the use of replacement fluids and the need for anticoagulation. (Clin. Exp. Neuroimmunol. doi: 10.1111/j.1759‐1961.2010.0010.x, 2010)

Plasmapheresis for neurological disorders

Apheresis is a general term that describes removal of abnormal blood constituents by extracorporeal blood purification methods. To date, therapeutic plasma exchange (PE) is the most common apheresis procedure. Here, plasma is separated from corpuscular blood constituents and replaced with a substitution fluid. In contrast to immunoadsorption, PE is a nonspecific treatment modality with elimination of the entire plasma. The therapeutic effect is based on the removal of circulating, pathogenic immune factors including autoantibodies. Currently, PE is used for treatment of several immune-mediated neurological disorders. While first experiences relate to acute life-threatening conditions, such as treatment of Guillain–Barré syndrome or myasthenic crisis, therapeutic success was also shown in chronic diseases where immunosuppressive therapy is often required for long-term management. PE has been applied successfully in chronic inflammatory demyelinating polyneuropathy, paraproteinemic polyneuropathy, stiff person syndrome, and may also be tried in several diseases of paraneoplastic origin. In recent years, PE was also established as an escalation therapy for steroid-unresponsive relapses of multiple sclerosis, and thus has gained more widespread attention. Adding to its increasing application in clinical practice, the procedure is usually well tolerated. Possible adverse reactions mainly relate to vascular access, the use of replacement fluids and the need for anticoagulation.

Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis

This study compares the effect of online-haemodiafiltration (o-HDF, post-dilution mode) with conventional haemodialysis (HD) and 'temperature-controlled' HD (Temp-HD) on the haemodynamic stability of hypotension-prone patients. Seventeen patients with a history of frequent hypotensive episodes during dialysis sessions were studied, each patient serving as his or her own control. The first 25 HD treatments in comparison with 25 o-HDF sessions were evaluated using identical dialysate temperature. In the second part of the study, o-HDF (n = 25) was compared with Temp-HD (n = 25). In the latter method, the temperature of the dialysate was adjusted to result in identical energy transfer rates to those in the corresponding o-HDF. The number of hypotensive episodes, blood temperature and blood volume regulation were assessed. Symptomatic hypotension was much more frequent during HD (40%) than during o-HDF (4%) (P < 0.001). During o-HDF, an enhanced energy loss within the extracorporeal system occurred (o-HDF, 16.6 +/- 4.0 W; HD, 5.4 +/- 5.1 W; P < 0.0001), despite identical temperature settings for dialysate and substitution fluid. As a result, the blood returning to the patient was cooler during o-HDF than during HD (o-HDF 35 +/- 0.2 degrees C vs HD 36.5 +/- 0.3 degrees C; P < 0.0001). In o-HDF, even in the patients' circulation, the mean blood temperature was lower (o-HDF 36.7 +/- 0.2 degrees C vs HD 36.9 +/- 0.3 degrees C; P < 0.0001) and blood volume was significantly more reduced (o-HDF, 91.8 +/- 3.1%; HD, 94.0 +/- 3.2%; P < 0.05). Energy transfer rates and blood temperature did not differ significantly between o-HDF and Temp-HD. The rate of hypotensive episodes was low and not different between o-HDF (4%) and Temp-HD (4%). Neither was there any significant difference in blood volume reduction. O-HDF showed a significant reduction of hypotensive episodes compared with HD. Surprisingly, o-HDF resulted in cooling of the blood via enhanced thermal energy losses within the extracorporeal system, despite use of replacement fluid prepared from pre-warmed dialysate. The incidence of symptomatic hypotension was reduced to that of o-HDF by using cooler Temp-HD. Thus, unexpected blood cooling appears to be the main blood pressure-stabilizing factor in o-HDF.

Effects of different sodium concentrations in replacement fluids during prolonged exercise in women

Objective: To investigate the effect of different sodium concentrations in replacement fluids on haematological variables and endurance performance during prolonged exercise. Methods: Thirteen female endurance athletes completed three four hour...