Hemostasis management and therapeutic plasma exchange

Results of a practice survey

Nicole D. Zantek, Leonard I. Boral, Yanhua Li, Chisa Yamada, Annika M. Svensson, Jason E. Crane, Roy E. Smith, Monica B. Pagano, Marian A. Rollins-Raval, Amy E. Schmidt, Edward C.C. Wong, Yanyun Wu

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations. Materials and methods: A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency (%) of respondents to each question. Results: Apheresis Medicine physicians, alone (59.4%) or jointly with the requesting provider (29.2%), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7% with no history of a bleeding or clotting disorder, 1.1% with active bleeding, and 8.8% with hypofibrinogenemia (<100 mg/dL) due to recent TPE. More respondents would use albumin with or without normal saline for replacement fluid when a minor invasive procedure (49.5%) vs a major surgery (8.9%) was performed 1 day before TPE. Replacement fluid selection varied among respondents for several other clinical conditions. The most frequent use for cryoprecipitate by respondents (14.3%) was hypofibrinogenemia. Conclusions: These survey results demonstrate wide interinstitutional variation in replacement fluid selection to manage hemostasis in patients undergoing TPE. Further studies are needed to guide optimal hemostasis management with TPE.

Original languageEnglish (US)
Pages (from-to)604-610
Number of pages7
JournalJournal of Clinical Apheresis
Volume33
Issue number5
DOIs
StatePublished - Oct 1 2018

Fingerprint

Plasma Exchange
Hemostasis
Therapeutics
Hemorrhage
Albumins
Surveys and Questionnaires
Blood Component Removal
Blood Coagulation Factors
Practice Management
Thrombosis
Blood Platelets
Software
Medicine
Guidelines
Physicians
Membranes

Keywords

  • anticoagulation
  • apheresis
  • bleeding
  • coagulation
  • plasmapheresis

PubMed: MeSH publication types

  • Journal Article

Cite this

Zantek, N. D., Boral, L. I., Li, Y., Yamada, C., Svensson, A. M., Crane, J. E., ... Wu, Y. (2018). Hemostasis management and therapeutic plasma exchange: Results of a practice survey. Journal of Clinical Apheresis, 33(5), 604-610. https://doi.org/10.1002/jca.21653

Hemostasis management and therapeutic plasma exchange : Results of a practice survey. / Zantek, Nicole D.; Boral, Leonard I.; Li, Yanhua; Yamada, Chisa; Svensson, Annika M.; Crane, Jason E.; Smith, Roy E.; Pagano, Monica B.; Rollins-Raval, Marian A.; Schmidt, Amy E.; Wong, Edward C.C.; Wu, Yanyun.

In: Journal of Clinical Apheresis, Vol. 33, No. 5, 01.10.2018, p. 604-610.

Research output: Contribution to journalArticle

Zantek, ND, Boral, LI, Li, Y, Yamada, C, Svensson, AM, Crane, JE, Smith, RE, Pagano, MB, Rollins-Raval, MA, Schmidt, AE, Wong, ECC & Wu, Y 2018, 'Hemostasis management and therapeutic plasma exchange: Results of a practice survey', Journal of Clinical Apheresis, vol. 33, no. 5, pp. 604-610. https://doi.org/10.1002/jca.21653
Zantek, Nicole D. ; Boral, Leonard I. ; Li, Yanhua ; Yamada, Chisa ; Svensson, Annika M. ; Crane, Jason E. ; Smith, Roy E. ; Pagano, Monica B. ; Rollins-Raval, Marian A. ; Schmidt, Amy E. ; Wong, Edward C.C. ; Wu, Yanyun. / Hemostasis management and therapeutic plasma exchange : Results of a practice survey. In: Journal of Clinical Apheresis. 2018 ; Vol. 33, No. 5. pp. 604-610.
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abstract = "Background: Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations. Materials and methods: A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency ({\%}) of respondents to each question. Results: Apheresis Medicine physicians, alone (59.4{\%}) or jointly with the requesting provider (29.2{\%}), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7{\%} with no history of a bleeding or clotting disorder, 1.1{\%} with active bleeding, and 8.8{\%} with hypofibrinogenemia (<100 mg/dL) due to recent TPE. More respondents would use albumin with or without normal saline for replacement fluid when a minor invasive procedure (49.5{\%}) vs a major surgery (8.9{\%}) was performed 1 day before TPE. Replacement fluid selection varied among respondents for several other clinical conditions. The most frequent use for cryoprecipitate by respondents (14.3{\%}) was hypofibrinogenemia. Conclusions: These survey results demonstrate wide interinstitutional variation in replacement fluid selection to manage hemostasis in patients undergoing TPE. Further studies are needed to guide optimal hemostasis management with TPE.",
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AU - Svensson, Annika M.

AU - Crane, Jason E.

AU - Smith, Roy E.

AU - Pagano, Monica B.

AU - Rollins-Raval, Marian A.

AU - Schmidt, Amy E.

AU - Wong, Edward C.C.

AU - Wu, Yanyun

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N2 - Background: Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations. Materials and methods: A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency (%) of respondents to each question. Results: Apheresis Medicine physicians, alone (59.4%) or jointly with the requesting provider (29.2%), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7% with no history of a bleeding or clotting disorder, 1.1% with active bleeding, and 8.8% with hypofibrinogenemia (<100 mg/dL) due to recent TPE. More respondents would use albumin with or without normal saline for replacement fluid when a minor invasive procedure (49.5%) vs a major surgery (8.9%) was performed 1 day before TPE. Replacement fluid selection varied among respondents for several other clinical conditions. The most frequent use for cryoprecipitate by respondents (14.3%) was hypofibrinogenemia. Conclusions: These survey results demonstrate wide interinstitutional variation in replacement fluid selection to manage hemostasis in patients undergoing TPE. Further studies are needed to guide optimal hemostasis management with TPE.

AB - Background: Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations. Materials and methods: A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency (%) of respondents to each question. Results: Apheresis Medicine physicians, alone (59.4%) or jointly with the requesting provider (29.2%), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7% with no history of a bleeding or clotting disorder, 1.1% with active bleeding, and 8.8% with hypofibrinogenemia (<100 mg/dL) due to recent TPE. More respondents would use albumin with or without normal saline for replacement fluid when a minor invasive procedure (49.5%) vs a major surgery (8.9%) was performed 1 day before TPE. Replacement fluid selection varied among respondents for several other clinical conditions. The most frequent use for cryoprecipitate by respondents (14.3%) was hypofibrinogenemia. Conclusions: These survey results demonstrate wide interinstitutional variation in replacement fluid selection to manage hemostasis in patients undergoing TPE. Further studies are needed to guide optimal hemostasis management with TPE.

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