The hemostatic imbalance of plasma-exchange transfusion
MA Flaum, RA Cuneo, FR Appelbaum, AB Deisseroth, WK Engel and HR Gralnick
Plasma exchange has been proposed as a treatment for multiple disorders.
Three patients with amyotropic lateral sclerosis, who were hemostatically
normal, were studied through a total of 11 4-liter exchanges. Plasma was
replaced by an equal volume of 5% albumin or 5% plasma protein fraction.
Serial studies revealed that immediately after the exchange transfusion,
there was significant prolongation of the prothrombin, partial
thromboplastin, and thrombin times with reduction of the fibrinogen and
antithrombin III levels. Factors V, VII-X, IX, and X were all significantly
decreased, as were the factor VIII antigen, procoagulant, and the
ristocetin cofactor activities. Platelet counts were obtained before and
after exchanges and revealed significant decreases. Four hours after
exchange, all parameters remained abnormal except the factor IX, ristocetin
cofactor, and factor VIII procoagulant activities. By 24 hr, all hemostatic
parameters had returned to normal. These studies indicate that
plasma-exchange transfusion with material devoid of coagulation factors
results in a coagulation defect that may be of clinical significance in a
hemostatically compromised patient.
Volume 54,
Issue 3,
pp. 694-702,
09/01/1979
Copyright © 1979 by The American Society of Hematology
