11Therapeutic apheresis: use of human serum albumin, fresh frozen plasma and cryosupernatant plasma in therapeutic plasma exchange
Section snippets
Human serum albumin
Between 70 and 80% of the oncotic activity in normal plasma is attributable to its albumin content, which averages 4.2 gm/dL.2 In the United States, a 5% solution of purified human serum albumin in normal saline is widely available in 250 and 500 mL bottles containing, respectively, 12.5 and 25 g of human serum albumin. A 4% solution is available and preferred in some other countries.3, 4
Fresh frozen plasma
The product name ‘fresh frozen plasma’ refers to a single donor plasma product that is frozen within 8 hours after collection and stored at −18 °C or below. It contains all known coagulation factors in therapeutically useful quantities. Plasma that is frozen between 8 and 24 hours after collection, sometimes called ‘24-hour plasma’, contains comparable levels of all coagulation factors except factor VIII; its factor VIII content is adequate for normal coagulation.29, 30
Replacement of patient
Cryosupernatant plasma
The material that remains after cryoprecipitate has been removed from fresh frozen plasma is a defined plasma product (plasma cryoprecipitate reduced) that is often called cryosupernatant plasma.37 It can be obtained from most blood suppliers. Cryosupernatant plasma is depleted of the constituents of cryoprecipitate, most notably the largest ‘normal’ vWF multimers. Prior to the discovery of the vWF-cleaving enzyme deficiency in thrombotic thrombocytopenic purpura, it was hypothesized that
Solvent/detergent plasma
Solvent/detergent plasma is pooled human plasma that has been treated with organic solvents and detergents to inactivate lipid-coated viruses, and then frozen in 200 mL aliquots.40 Compared to fresh frozen plasma, solvent/detergent plasma is relatively deficient in certain inhibitory molecules–proteins C and S in the coagulation cascade, α2-antiplasmin and α1-antitrypsin. It contains the vWF cleaving protease but, like cryosupernatant plasma, is depleted of the largest ‘normal’ vWF multimers.
Summary
A 4–5% solution of human serum albumin in normal saline is the most commonly chosen replacement fluid for plasma exchange. This isotonic, iso-oncotic product offers unmatched viral safety and ease of administration combined with a very low risk of either febrile or allergic reactions. Fresh frozen plasma is an appropriate choice in thrombotic thrombocytopenic purpura and in other instances in which replenishing normal plasma proteins such as coagulation factors is deemed important. Neither
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Thawed plasma (TP) as a substitute for intravenous immune globulin (IVIG) to prevent hypogammaglobulinemia post-therapeutic plasma exchange
2023, Transfusion and Apheresis ScienceAttenuation of age-elevated blood factors by repositioning plasmapheresis: A novel perspective and approach
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2021, Transfusion and Apheresis ScienceCitation Excerpt :A crucial component of the procedure is the replacement of plasma with an equivalent volume largely composed of iso-oncotic fluid, to prevent hypotension or fluid imbalance following the procedure. A number of fluids are commonly utilized for this purpose including 4–5 % human albumin suspended in normal saline, normal saline, and donor plasma, each with their respective advantages and disadvantages [3]. The choice and relative quantity of each fluid further depends on the indication for PLEX as well as patient factors.
Albumin-based nanomaterials in drug delivery and biomedical applications
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2020, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :In patients with congenital TTP, routine TPE may not be required and these patients can be managed with serial plasma infusion when there is a congenital quantitative ADAMTS13 deficiency and no ADAMTS13 inhibitors.73 While 5% albumin is the most commonly used replacement fluid in many TPE applications, plasma is preferred in TTP because it contains ADAMTS13, which is deficient in TTP.15 Cryoprecipitate poor plasma may also be used in TTP and has the advantage of having minimal VWF content.
The use of emergency apheresis in the management of plasma cell disorders
2018, Transfusion and Apheresis ScienceCitation Excerpt :Experience with its effectiveness is limited and the cost is relatively high of price [8]. Because centrifugation based plasma separation provides bulk removal of plasma, anything circulating in plasma will be removed; a plasmapheresis procedure requires a replacement fluid [9]. The most commonly used replacement fluid is 4%–5% human albumin in physiologic saline.