title: Techniques and applications of perioperative therapeutic plasma exchange.
abstract: OBJECTIVE
  Therapeutic plasma exchange (TPE) is a useful adjunct in the management of antibody-mediated disorders. The indications for TPE now include the perioperative setting. This review updates the anesthesiologist on the relevant clinical indications and precautions of plasma exchange.
  
  
  RESULTS
  Although still considered experimental, TPE for heparin-induced thrombocytopenia for urgent cardiac surgery is the most promising recent advance.
  
  
  CONCLUSIONS
  Plasmapheresis, or TPE, removes monoclonal antibodies, immune complexes and paraproteins. The utility of TPE in the perioperative period has recently become more apparent. Antibody-mediated disorders are associated with postoperative morbidity and mortality and are treated with TPE. Indications for TPE for cardiac surgery include heparin-induced thrombocytopenia, thrombotic thrombocytopenia purpura and antiphospholipid syndrome. Other indications for perioperative TPE are typically related to immunomodulation during solid-organ transplant. Immunomodulation, primarily with immunosuppressive medications and TPE, of a previously allosensitized recipient pretransplant increases the likelihood of a successful match. TPE is also useful in the management of intentional and inadvertent ABO incompatible recipients and is essential in the treatment of hyperacute rejection. TPE will likely be more utilized in the future and understanding the essentials of the procedure will facilitate the perioperative management of antibody-mediated disorders.
authors: aDepartment of Anesthesiology, University of Maryland, Baltimore, Maryland bDepartment of Anesthesiology, Duke University Medical Center, Durham cDivision of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
authors: Philip E F
authors: PE
authors: Roman
authors: Adam D
authors: AD
authors: DeVore
authors: Ian J
authors: IJ
authors: Welsby
mesh_terms: D000017:ABO Blood-Group System; D000925:Anticoagulants / Q000009:adverse effects; D001787:Blood Group Incompatibility; D006348:Cardiac Surgical Procedures / Q000379:methods; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D016377:Organ Transplantation; D019990:Perioperative Care / Q000379:methods*; D010951:Plasma Exchange / Q000379:methods*; D011183:Postoperative Complications / Q000628:therapy; D011696:Purpura, Thrombocytopenic / Q000188:drug therapy / Q000209:etiology; D019616:Thoracic Surgical Procedures / Q000379:methods; D013921:Thrombocytopenia / Q000139:chemically induced / Q000628:therapy; D013927:Thrombosis / Q000188:drug therapy
chemical_list: D000017:ABO Blood-Group System; D000925:Anticoagulants; D006493:Heparin