Partial plasma exchange, and adjunct in therapy to complex clinical problems.

Abstract

The use of therapeutic partial plasma exchange (PPE) is reviewed as an adjunct in the treatment of certain complex clinical problems. The procedure is performed with a Model 30 Haemonetics Blood Cell Separator in which the patient's plasma is partially exchanged with fresh frozen plasma, fresh frozen plasma with cryoprecipitate removed or with plasma protein fraction. The present study describes the use of PPE on 12 patients within the last 15 months as a means of altering the plasma proteins to achieve certain therapeutic goals. The study consists of six procoagulant deficient patients (five congentital and one acquired) in which five of the six patients responded by reflecting a satisfactory rise in the plasma procoagulant level following the procedure, resulting in cessation of bleeding. The sixth patient was thought to have had a procoagulant inhibitor, thus the procoagulant level was changed only minimally. The remaining six patients (five with hyperviscosity syndrome and one with platelet antibody) responded only to the degree of the intensiveness of the PPE procedure. More aggressvie, repeated PPE and/or plasmapheresis are needed if the clinical objective is to decrease the plasma viscosity or to lower a humoral antibody within the patient's plasma.