title: Fibrinogen reduction and bleeding complications in plasma exchange, immunoadsorption and a combination of the two.
abstract: BACKGROUND
  Immunoadsorption (IAS) and therapeutic plasma exchange (TPE) are considered safe although fibrinogen is removed. To date no comparison of fibrinogen reduction and associated risk of bleeding in apheresis exists.
  
  
  METHODS
  Retrospective analysis of TPE, three IAS adsorbers, and combined TPE/IAS regarding fibrinogen reduction and bleeding incidence in 67 patients (1,032 treatments).
  
  
  RESULTS
  TPE and TPE/IAS reduced fibrinogen by 64 ± 11% and 58 ± 9%, leading to concentrations <100 mg/dl in 20 and 17% of treatments, respectively. IAS decreased fibrinogen less than TPE (26 ± 6%, p < 0.0001), resulting in fibrinogen concentrations <100 mg/dl in 1% of treatments. The processed volume correlated with reduction in TPE (r = 0.64, p < 0.01), but not in IAS. Bleeding occurred in 1.3% (IAS), 2.3% (TPE) and 3.1% (TPE/IAS) of treatments.
  
  
  CONCLUSIONS
  Hypofibrinogenemia occurs in 20% of patients after TPE and TPE/IAS, but rarely after IAS. IAS removes fibrinogen independently of volume processed. Overall, bleeding is rare in apheresis.
authors.affiliation: Internal Medicine III/Clinical Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
authors.forename: Simon
authors.initials: S
authors.lastname: Zöllner
authors.forename: Eleonore
authors.initials: E
authors.lastname: Pablik
authors.forename: Wilfred
authors.initials: W
authors.lastname: Druml
authors.forename: Kurt
authors.initials: K
authors.lastname: Derfler
authors.forename: Andrew
authors.initials: A
authors.lastname: Rees
authors.forename: Peter
authors.initials: P
authors.lastname: Biesenbach
mesh_terms: D000328:Adult; D005260:Female; D005340:Fibrinogen / Q000302:isolation & purification*; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007163:Immunosorbent Techniques / Q000009:adverse effects / Q000295:instrumentation*; D007164:Immunosorbents / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology / Q000628:therapy; D009157:Myasthenia Gravis / Q000473:pathology / Q000628:therapy; D010951:Plasma Exchange / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D010956:Plasmapheresis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D007164:Immunosorbents; D005340:Fibrinogen