title: Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective.
abstract: Therapeutic plasma exchange (TPE) is an effective treatment in Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) and 5% human albumin is the replacement fluid of choice; however, it is expensive. More recently, it has been suggested that starch is a safe and cheaper choice to human albumin.
  
  
  OBJECTIVE
  To evaluate our 5-year experience using 3% hydroxyethyl starch (HES) and 5% human albumin mixture, as replacement fluid in TPE for these diseases.
  
  
  METHODS
  Retrospective study carried out from January 2001 through September 2006. We included those patients with MG and GBS undergoing TPE. We analyzed clinical outcome (CO) and adverse events (AE) and our results were compared with a previous study which included similar patients undergoing TPE using just 5% human albumin.
  
  
  RESULTS
  Thirty-one procedures were carried out in 26 patients, a total of 147 TPE sessions. In the group of MG we had 57% complete responses (CR) and 86% overall response (OR) while in the group of GBS we had 40% CR and 60% OR. When we analyzed our CO with the previous study no statistical differences were found. Mean processed plasma volume (PPV) was 4.2 in MG and 5.5 in GBS. Twenty patients had AE, being hypotension and catheter dysfunction the most frequent ones, while tachycardia, hypertension and paresthesias were statistically more frequent in the HES/albumin group.
  
  
  CONCLUSIONS
  TPE with a mixture of 3% HES and 5% human albumin is as effective and safe as 5% human albumin alone for patients with these diseases.
authors.affiliation: Department of Hematology-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF, México. patyr2mi@hotmail.com
authors.forename: Gladys P
authors.initials: GP
authors.lastname: Agreda-Vásquez
authors.forename: Irma
authors.initials: I
authors.lastname: Espinosa-Poblano
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Sánchez-Guerrero
authors.forename: Erick
authors.initials: E
authors.lastname: Crespo-Solís
authors.forename: Siram
authors.initials: S
authors.lastname: Cabrera-Vásquez
authors.forename: Josefa
authors.initials: J
authors.lastname: López-Salmorán
authors.forename: Josefina
authors.initials: J
authors.lastname: Barajas
authors.forename: Paula
authors.initials: P
authors.lastname: Peñaloza-Ramírez
authors.forename: Nelly
authors.initials: N
authors.lastname: Tirado-Cárdenas
authors.forename: Antonio
authors.initials: A
authors.lastname: Velázquez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D020275:Guillain-Barre Syndrome / Q000628:therapy*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy*; D010951:Plasma Exchange; D010952:Plasma Substitutes / Q000009:adverse effects / Q000494:pharmacology; D012189:Retrospective Studies; D012709:Serum Albumin
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012709:Serum Albumin