Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lee MY (1); Lo YP (1); Man MY (1) ; Ma HY (2) ; Shum HP (1) ; Yan WW (1)
Affiliation :
(1)Pamela Youde Nethersole Eastern Hospital, Department of Intensive Care, Chai Wan, Hong Kong, SAR China, (2)Tuen Mun Hospital , Department of intensive care , Tuen Mun , Hong Kong, SAR China
Introduction :
Therapeutic plasma exchange (TPE) is widely used in ICUs. Membrane based TPE(mTPE) (Prismaflex prismafilter TPE 2000) is based on molecular size while centrifugal based TPE(cTPE) (Spectra Optia apheresis system) is based on molecular density. Limited data was available on the efficacy and efficiency of the two types of TPE.
Objectives :
This study aims to compare the performance of mTPE and cTPE in terms of plasma removal efficiency in our locality.
Methodology :
A retrospective study including patients admitted to two ICUs in HK for TPE from 1st January 2021 to 30th September 2023 was conducted. Patients’ demographics, clinical parameters, and outcomes were collected. Treatment details of TPE, anticoagulation used, pre- and post-TPE laboratory data were recorded. Primary outcome was the plasma removal efficiency calculated by hourly plasma volume removed. Mann-Whitney U test was used for continuous variables and Wilcoxon signed rank test was used to compare pre- and post-TPE laboratory data.
Result & Outcome :
There were 150 TPE sessions performed on 41 patients. The main indications were autoimmune neurological diseases (26.5%) and liver failure (26.8%). The median hourly plasma removal rate by cTPE was significantly higher (2199vs1020 ml/hr (p< 0.001) and accounting only one-third of the treatment time of mTPE (80 vs 240 minutes, p< 0.001). Albumin loss was more significant after cTPE (4vs 2g/L, p< 0.001). Circuit clotting occurred in 17% of the sessions, all of them by mTPE, majority used low molecular weight heparin (LMWH) as anticoagulant (88.23%). More patients experienced transient hypotension during cTPE (2 vs 4, p = 0.414). This study shows that cTPE is more efficient in plasma removal than mTPE. Circuit clotting occurs commonly in those using LMWH as anticoagulant. Both modalities are safe even in critically ill setting.
