Contributions
Abstract: PB2527
Type: Publication Only
Background
Therapeutic plasma exchange (TPE) involves removal of plasma containing pathological circulating auto-antibodies and immune complexes from the patient and artificial replacement with a colloid solution (e.g albumin and/or plasma) or a combination with a crystalloid solution to maintain euvolaemia. Many renal disorders have an immune-mediated pathogenesis and the ability of TPE to rapidly lower serum immunoglobulins makes this treatment a first line option. The type of fluid used for performing TPE varies significantly between hospitals and clinicians due to the lack of robust evidence on optimal fluid type.
Aims
To understand TPE practice by reviewing the indications for TPE, fluid type used and number of exchange sessions and to determine if variabilities in type of fluid used in patients with similar renal conditions exist.
Methods
Four year retrospective single centre study of TPE practice between February 2014 and December 2017, at the renal unit at Barts Health NHS Trust.
Results
134 patients underwent TPE between February 2014 and December 2017 (50% were male). The median age was 52 years (age range 19-89), and of the total, 89% received TPE for renal disease while the remainder had an underlying neurological diagnosis. The most common renal indications were vasculitis with pulmonary haemorrhage (13.4%), IgA nephropathy (7.6%), transplant rejection (6.7%) and HLA incompatibility (6.7%). The maximum number of TPE sessions received was 6 (sessions range 1-6). The majority of the patients, 53.7%, received human albumin solution (4.5% HAS) during their first session, while 29.9% received Octaplas (solvent detergent treated plasma) and 14.2% received a 50:50 mix of 4.5% HAS and Octaplas. Variability in fluid type used for patients with similar renal conditions was observed. 43.8% of patients with vasculitis and pulmonary haemorrhage received Octaplas in the first session, while 31% received 4.5% HAS and the remainder (25%) received a 50:50 mix of 4.5% HAS and Octaplas. 55.6% patients with IgA nephropathy received 4.5% HAS during their first session while 33.3% received Octaplas. In patients with HLA incompatibility, 62.5% received 4.5% HAS during session one and 37.5% received Octaplas. 50% of patients who required TPE for transplant rejection received Octaplas during the first session, 25% received 4.5% HAS and 12.5% received either a 50:50 mix or normal saline.
Conclusion
Although indications for TPE in our unit are similar to what is evidenced in literature, there is variability in type of fluid used per TPE session in patients with similar underlying renal pathology. Further prospective studies are therefore required to determine what optimal fluid type should be utilised
Session topic: 32. Transfusion medicine
Keyword(s): Apheresis, Plasma, Renal
Abstract: PB2527
Type: Publication Only
Background
Therapeutic plasma exchange (TPE) involves removal of plasma containing pathological circulating auto-antibodies and immune complexes from the patient and artificial replacement with a colloid solution (e.g albumin and/or plasma) or a combination with a crystalloid solution to maintain euvolaemia. Many renal disorders have an immune-mediated pathogenesis and the ability of TPE to rapidly lower serum immunoglobulins makes this treatment a first line option. The type of fluid used for performing TPE varies significantly between hospitals and clinicians due to the lack of robust evidence on optimal fluid type.
Aims
To understand TPE practice by reviewing the indications for TPE, fluid type used and number of exchange sessions and to determine if variabilities in type of fluid used in patients with similar renal conditions exist.
Methods
Four year retrospective single centre study of TPE practice between February 2014 and December 2017, at the renal unit at Barts Health NHS Trust.
Results
134 patients underwent TPE between February 2014 and December 2017 (50% were male). The median age was 52 years (age range 19-89), and of the total, 89% received TPE for renal disease while the remainder had an underlying neurological diagnosis. The most common renal indications were vasculitis with pulmonary haemorrhage (13.4%), IgA nephropathy (7.6%), transplant rejection (6.7%) and HLA incompatibility (6.7%). The maximum number of TPE sessions received was 6 (sessions range 1-6). The majority of the patients, 53.7%, received human albumin solution (4.5% HAS) during their first session, while 29.9% received Octaplas (solvent detergent treated plasma) and 14.2% received a 50:50 mix of 4.5% HAS and Octaplas. Variability in fluid type used for patients with similar renal conditions was observed. 43.8% of patients with vasculitis and pulmonary haemorrhage received Octaplas in the first session, while 31% received 4.5% HAS and the remainder (25%) received a 50:50 mix of 4.5% HAS and Octaplas. 55.6% patients with IgA nephropathy received 4.5% HAS during their first session while 33.3% received Octaplas. In patients with HLA incompatibility, 62.5% received 4.5% HAS during session one and 37.5% received Octaplas. 50% of patients who required TPE for transplant rejection received Octaplas during the first session, 25% received 4.5% HAS and 12.5% received either a 50:50 mix or normal saline.
Conclusion
Although indications for TPE in our unit are similar to what is evidenced in literature, there is variability in type of fluid used per TPE session in patients with similar underlying renal pathology. Further prospective studies are therefore required to determine what optimal fluid type should be utilised
Session topic: 32. Transfusion medicine
Keyword(s): Apheresis, Plasma, Renal