背景:血浆置换可以消耗致病性抗体,并允许ABO和/或HLA不相容的移植。
目的:为了确定血浆置换的三种方式的影响(离心血浆置换[cTPE],单过滤血浆置换[mTPE],双重过滤血浆置换[DFPP])对止血参数和凝血酶生成的影响。
方法:前瞻性,对21例接受三种血浆置换方式的患者进行比较研究(7例患者/组)。止血(凝血酶原时间[PT],活化部分凝血活酶时间[aPTT],促凝血因子和天然抗凝剂)在第一次血浆置换之前和之后进行测量。在每组4-5名患者中,还使用STA-Genesia(Stago)分析仪和血栓筛查试剂(Stago)评估了血小板不足血浆中的凝血酶生成。
结果:cTPE和mTPE均导致蛋白质大量减少,无论它们的分子量如何。对于大多数蛋白质(除了FVIII[0.64]和VWF[0.57]),cTPE的中位后/前比率为0.27至0.55。对于所有蛋白质,mTPE的中位后/前比率为0.28至0.56。DFPP降低了高分子量蛋白(纤维蛋白原,FV,FVIII,FXI,VWF)和蛋白质与大分子(蛋白质SandTFPI)强烈结合。cTPE和mTPE的中值后/前比率与纤维蛋白原和FXIII的DFPP相似。关于凝血酶的产生,cTPE和mTPE没有显著改变内源性凝血酶潜能(ETP),并且在不存在血栓调节蛋白的情况下,DFPP诱导ETP的轻微降低(中值后/前比率为0.73)。在所有程序中,血栓调节蛋白对ETP的抑制作用均降低。
结论:与cTPE和mTPE相比,DFPP耗尽了高分子量蛋白,显着减少所有蛋白质。关于凝血酶的产生,无论使用何种血浆置换方法,某些天然抗凝剂的减少都抵消了促凝血因子的消耗;所有方法,纤维蛋白原和FXIII高度耗尽.
BACKGROUND: Plasmapheresis can deplete pathogenic antibodies and allow ABO- and/or HLA-incompatible transplantation.
OBJECTIVE: To determine the impacts of three modalities of plasmapheresis (centrifugal plasmapheresis [cTPE], single-filtration plasmapheresis [mTPE], double-filtration plasmapheresis [DFPP]) on hemostasis parameters and thrombin generation.
METHODS: Prospective, comparative study on 21 patients that received three modalities of plasmapheresis (7 patients/group). Hemostasis (prothrombin time [PT], activated partial thromboplastin time [aPTT], procoagulant factors and natural anticoagulants) were measured before and after the first plasmapheresis session. Thrombin generation was also assessed in platelet-poor plasma using an STA-Genesia (Stago) analyzer and Thromboscreen reagents (Stago) in 4-5 patients from each group.
RESULTS: Both cTPE and mTPE resulted in high decreases in proteins, whatever their molecular weights. Median post/pre ratios were 0.27 to 0.55 for cTPE for most proteins (except FVIII [0.64] and VWF [0.57]). Median post/pre-ratios of mTPE were 0.28 to 0.56 for all proteins. DFPP decreased high-molecular-weight proteins (fibrinogen, FV, FVIII, FXI, VWF) and proteins strongly bound to large molecules (protein SandTFPI). Median post/pre ratios with cTPE and mTPE were similar to DFPP for fibrinogen and FXIII. Regarding thrombin generation, cTPE and mTPE did not significantly modify endogenous thrombin potential (ETP) and DFPP induced a slight decrease in ETP (median post/pre ratio at 0.73) in the absence of thrombomodulin. ETP inhibition by thrombomodulin was decreased for all procedures.
CONCLUSIONS: DFPP depleted high molecular-weight proteins in contrast to cTPE and mTPE, which significantly decreased all proteins. Regarding thrombin generation, depletion of procoagulant factors was counterbalanced by a decrease in some natural anticoagulants whatever plasmapheresis method used; with all methods, fibrinogen and FXIII were highly depleted.