title: Major coagulation disturbances during fractionated plasma separation and adsorption.
abstract: Fractionated Plasma Separation and Adsorption (FPSA) is a novel nonbiologic detoxification system for the removal of protein-bound solutes. FPSA is used to bridge patients during fulminant liver failure, either to functional recovery or to liver transplantation. Besides liver failure associated protein bound solutes, several important uremic retention solutes share important protein binding. We observed repeated occlusive thrombosis of the arterio-venous conduit during FPSA in hemodialysis (HD) patients, resulting in acute loss of function. A major reduction of several coagulation factors was demonstrated, exceeding 50% for factor II, factor X and protein C. Broad disturbances of the coagulation system were confirmed in FPSA treated liver failure patients. An ex vivo recirculation model demonstrated nonspecific adsorption of coagulation factors protein S and protein C on the anion exchange cartridge. Direct contact between fractionated plasma and the Prometh02 anion exchanger causes significant adsorption of procoagulant and anti-coagulant factors, associated with clinically relevant adverse events.
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital Leuven, Leuven, Belgium.
authors.forename: B K I
authors.initials: BK
authors.lastname: Meijers
authors.forename: P
authors.initials: P
authors.lastname: Verhamme
authors.forename: F
authors.initials: F
authors.lastname: Nevens
authors.forename: M F
authors.initials: MF
authors.lastname: Hoylaerts
authors.forename: B
authors.initials: B
authors.lastname: Bammens
authors.forename: A
authors.initials: A
authors.lastname: Wilmer
authors.forename: J
authors.initials: J
authors.lastname: Arnout
authors.forename: Y
authors.initials: Y
authors.lastname: Vanrenterghem
authors.forename: P
authors.initials: P
authors.lastname: Evenepoel
mesh_terms: D000293:Adolescent; D000327:Adsorption; D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005170:Factor X / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D017114:Liver Failure, Acute / Q000097:blood / Q000628:therapy*; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects* / Q000295:instrumentation; D011379:Prognosis; D011486:Protein C / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D006435:Renal Dialysis; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood / Q000209:etiology*
chemical_list: D011486:Protein C; D011516:Prothrombin; D005170:Factor X