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Abstract: SA-PO174

Effects of Primer on Episodes of Hypotension during Therapeutic Plasma Exchange

Session Information

Category: Onconephrology

  • 1700 Onconephrology

Authors

  • Ray, Madhab, University of California Davis, Davis, California, United States
  • Macadam, Anna Grace, University of California Davis, Davis, California, United States
  • Monis, Grace, University of California Davis, Davis, California, United States
Background

Plasma pheresis instruments are primed (pre-filled with a fluid) before Therapeutic Plasma Exchange (TPE) with saline solution or 5% albumin to prevent air embolism and hypovolemia from extracorporeal fluid shift. Changes in blood composition during TPE can cause various side effects, including hypotension through the involvement of the autonomic nervous system. No published study compares effect on hypotension when an albumin solution is used instead of normal saline. The purpose of this study was to characterize the blood pressure response during TPE when albumin is used for priming compared to normal saline.

Methods

Data was retrospectively collected from 118 TPE records of 26 patients who had one or more TPEs in the last two years at UC Davis Medical Center, California. TPE was done according to Spectra Optia System guidelines, and no patient had more than one exchange on a particular day. Five percent human albumin was used as the preferred replacement fluid, and the dose was calculated based on the body weight, height, sex, and age of the patients. Patients were closely monitored during the procedure. Changes in mean arterial blood pressures were compared to their respective baseline using unpaired two-tailed t-test. Episodes of hypotension (SBP <90 mm Hg or DBP <60 mmHg) during TPE were analyzed using Anova.

Results

The mean age of patients was 51 years and 42% were male. Hypotension was noted more frequently and with increased severity when 5% human albumin was used for priming the plasma apheresis system. Significant increase was noted both in severity (p-value < 0.01) and frequency of hypotensive episodes (p-value <0.001) when 5% human albumin was used for priming the plasma apheresis system (figure 1).

Conclusion

Episodes of hypotension were less frequent and less severe during therapeutic plasma exchange when the plasma apheresis system was primed with saline compared to 5% human albumin. Results may reflect the heterogenous pathophysiology of our study population. Further studies will be necessary to generalize these observations.

Figure 1