Thromboelastometric evaluation of changes in coagulation dynamics following therapeutic plasma exchange using different replacement fluids

Abstract

Background: Therapeutic plasma exchange (TPE) decreases clotting factors and cellular blood components. Choice of replacement fluid can be important factor in outcome of therapeutic large volume plasma exchange.ObjectiveThis study aimed to evaluate changes in coagulation parameers using thromboelastography (TEG) prior and post-plasma exchange with albumin alone or with fresh frozen plasma (FFP). DesignThis is prospective comparative study. Materials and Methods: A prospective comparative study carried out in the Department of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, from 1st September 2016 to 31st December 2017 in the patients of renal allograft recipient or post renal transplant. Results: A total of 47 chronic kidney disease(CKD) patients were included.TEG analysis before and after TPE procedures revealed a relatively hypo-coagulable state when albumin only was used as a replacement fluid. The R (3.489±0.9136 vs 7.669±1.695) and K (3.09±0.50 vs 6.611±1.588) increased while alpha angle value (38.10±7.83 vs 34.92±7.564) decreased (p value & lt; 0.001).The mean increase in R value was more pronounced (4.18 vs 0.39) in TPE with albumin only compare to TPE with albumin and FFP group (p value & lt; 0.005). Conclusion: Blood coagulation parameters measured by TEG analysis showed a significant decrease in clotting factors in patients where TPE was performed with only albumin as replacement fluid.