Hemodynamic study of serial double-filtration plasmapheresis.
Although hypotension is a potential complication for all procedures involving extracorporeal circulation, including plasmapheresis, the effects of serial double-filtration plasmapheresis (DFP) on hemodynamic status have rarely been reported. Blood pressure (BP) and pulse rate (PR) were prospectively monitored at 30-minute intervals (baseline, M30, M60, M90, and Ml20) during procedures for 20 myasthenia gravis patients who underwent one course of five consecutive DFP treatments on alternate days, with hemodynamic parameters recorded and analyzed for all sessions. To evaluate the hemodynamic influence of protein loss resulting from serial DFP treatment, additional analysis of serum protein levels including albumin and globulin was conducted before and after the entire course of treatment. Longitudinal analysis on the systolic BP (SBP) changes over five sessions revealed that the SBP at baseline and at M30 dropped significantly during the third and fourth sessions, in comparison to the first (P < 0.05). By contrast, SBP at M120 rose significantly (P < 0.05) after the second session of treatment. A similar trend was revealed for the diastolic BP (DBP) with a significant fall recorded at baseline and at M30 for the fourth session. The PR did not differ significantly during consecutive DFP treatments. Globulin removal rates were correlated significantly with falls in SBP (r(2) = 0.250, P = 0.048) and DBP (r(2) = 0.405, P = 0.008). However, analogous albumin removal rate was not correlated with these hemodynamic parameters. In conclusion, our results confirm that hypoproteinemia is an important factor for contributing to unstable hemodynamics during serial DFP.
Yeh
Jiann-Horng
JH
Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen-Chang Road, Shih-Lin district, Taipei, Taiwan.
Chen
Wei-Hung
WH
Chiu
Hou-Chang
HC
D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000503:physiopathology / Q000628:therapy; D001794:Blood Pressure; D001810:Blood Volume; D005260:Female; D005374:Filtration; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007019:Hypoproteinemia / Q000209:etiology; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000503:physiopathology / Q000628:therapy; D010956:Plasmapheresis / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin