title: Coagulation profile after plasma exchange using albumin as a replacement solution measured by thromboelastometry.
abstract: BACKGROUND
  Significant decrease in fibrinogen and other coagulation proteins is observed after plasma exchange when albumin is used as a replacement fluid. Little is known about how those changes impact on thromboelastometry (TEM). The aim of this study was to describe the changes in TEM after performing plasma exchange procedures using 5% albumin as a replacement fluid and its correlation with the standard coagulation tests.
  
  
  METHODS
  Consecutive patients treated with plasma exchange were prospectively recorded. We performed laboratory and TEM assays extrinsec patway [EXTEM and fibrin-based TEM (fibTEM)] from patient's blood sampled immediately before starting and immediately after finishing each procedure. Bleeding events during and after the procedure were monitored. Mann-Whitney U-test and Spearman's correlation test were used when needed.
  
  
  RESULTS
  After plasma exchange, all TEM parameters decreased under normal limits, especially the clotting time (CT): 62% reduction (range: 35-84%) and the fibTEM: 50% (range: 62-27%); maximum clot firmness (MCF) decreased to a lesser extent, 23% (range: 29-21%). Main TEM parameters showed a strong correlation with fibrinogen values: CT, r = -0·81; MCF, r = 0·85; and fibTEM, r = 0·79. No bleeding complications were observed.
  
  
  CONCLUSIONS
  A profound derangement of TEM parameters was observed after PE, evidenced by delay in the clot formation and reduction in the clot firmness. More studies are warranted to elucidate the clinical implications of derangement in TEM parameters in patients without concomitant coagulopathy.
authors.affiliation: Anesthesia Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Blasi
authors.affiliation: Hemotherapy and Hemostasis Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cid
authors.affiliation: Anesthesia Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Beltran
authors.affiliation: Anesthesia Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Taurà
authors.affiliation: Anesthesia Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Balust
authors.affiliation: Hemotherapy and Hemostasis Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.identifier: http://orcid.org/0000-0003-2593-833X
authors.initials: M
authors.lastname: Lozano
mesh_terms: D000328:Adult; D000418:Albumins / Q000009:adverse effects* / Q000494:pharmacology; D001777:Blood Coagulation / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods*; D013916:Thrombelastography
chemical_list: D000418:Albumins
keywords: bleeding; plasma exchange; thromboelastometry