Therapeutic apheresis (plasma exchange or cytapheresis): Complications
- Andre A Kaplan, MD
Andre A Kaplan, MD
- Professor of Medicine
- University of Connecticut Health Center
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
Therapeutic apheresis is an extracorporeal treatment that separates blood components (plasma and/or cellular components) from the patient's blood for the treatment of conditions in which a pathogenic substance in the blood is causing morbidity. Therapeutic plasma exchange (TPE) denotes the selective removal of a patient’s plasma and replacement with another fluid; cytapheresis refers to selective removal of abnormal or excessive numbers of blood cells.
This topic review will discuss the complications of therapeutic apheresis. An overview of the terminology used to describe apheresis procedures; the types of indications for which therapeutic apheresis is effective, including American Society for Apheresis (ASFA) therapeutic categories; and practical issues in apheresis techniques are discussed separately. (See "Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology".)
An overview to the patient with a suspected acute transfusion reaction is also presented separately. (See "Approach to the patient with a suspected acute transfusion reaction".)
OVERVIEW OF COMPLICATIONS
The basic premise of therapeutic apheresis is that removal of certain pathologic substances (or cells, in cytapheresis) will reduce organ or tissue damage and may permit reversal of a pathologic process. In order to prevent volume depletion during therapeutic plasmapheresis, the volume of plasma removed must be replaced by plasma, colloid, or crystalloid. In some cases, use of allogeneic (donor) plasma is preferred because it provides needed proteins or other factors; however, donor plasma should be avoided if possible, other than when it is indicated as replacement fluid, such as for thrombotic thrombocytopenic purpura, in which it provides needed proteins or other factors. (See "Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology", section on 'Replacement fluids'.)
The frequency and types of complications from therapeutic apheresis depends upon the overall condition of the patient, the number of procedures, the replacement fluid, and the venous access device. A review of the reported complications from over 15,000 therapeutic plasma exchange (TPE) treatments found that adverse reactions were substantially more common with plasma than with albumin replacement (20 versus 1.4 percent) .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- OVERVIEW OF COMPLICATIONS
- ANY REPLACEMENT FLUID
- Citrate-induced hypocalcemia
- Citrate-induced metabolic alkalosis
- Inadvertent removal of a medication
- Vascular catheter complications
- NON-PLASMA REPLACEMENT FLUIDS
- Coagulation factor depletion
- Immunoglobulin depletion
- Angiotensin converting enzyme (ACE) inhibitor-related complications
- DONOR PLASMA OR RED BLOOD CELL EXPOSURE
- Anaphylactic reactions
- Transfusion-related acute lung injury (TRALI)
- Infectious risks of plasma or RBC
- EVALUATION FOR SUSPECTED COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS