EXPERIENCE OF PLASMAPHERESIS PERFORMED WITH CRRT MONITORS BY ICU STAFF

Plasmapheresis (PF) is an extracorporeal blood purification technique designed to remove large molecular weight particles from plasma. There is growing evidence on the benefit of this technique in different clinical diseases that would deserve intensive care.


Introduction
Plasmapheresis (PF) is an extracorporeal blood purification technique designed to remove large molecular weight particles from plasma. There is growing evidence on the benefit of this technique in different clinical diseases that would deserve intensive care.

Objectives
To report our experience in PF performed with CRRT monitors (Prismaflex ® System, Gambro) with a filter membrane, which allows the removal of particles up to 3x10 6 Da. To analyze the characteristics of our patients, the technique and its complications.

Methods
Assessment of all the PF sessions carried out in a 12-bed medical ICU in Spain (October 2013-February 2015. Hemodynamic data were measured before and during each session. Haematological and biochemical parameters were analyzed before, at the end of each session, and thereafter following a recovery period (13.9 ± 0.5 hours). Statistical paired analysis was made by Wilcoxon test.
Transient significant leukocytosis with no signs of infection developed after PF. This was due to an increase in the neutrophils count (6.4 ± 2.5 to 12.4 ± 5.3 cells 10 3 /µL,p < 0.05); lymphocytes trend to decrease although without reaching statistical significance (1.9 ± 1.5 to 1.6 ± 1 cells 10 3 /µL,p= 0.09). Although serum Sodium and Chloride varied significantly with PF, their levels remained within normal ranges, whereas serum Potassium remained stable due to replacement fluid concentration administered.
Complications detected were coagulation of extracorporeal system(n = 1), catheter thrombosis(n = 1) and femoral catheter contamination(n = 1) due to indwelling catheter urinary tract infection. No major bleeding, or therapy-related deaths were registered.

Conclusions
PF is a safe therapy performed with CRRT monitors by ICU staff. Hemodynamic, hematological and biochemical changes occur with no related symptoms whether early appropriate adjustment is established. Close electrolytes monitoring for prompt correction is mandatory.

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