PENTASTARCH INSTEAD OF ALBUMIN AS REPLACEMENT FLUID FOR THERAPEUTIC PLASMA-EXCHANGE

BACKGROUND: Human albumin is commonly used as a replacement fluid in t herapeutic plasma exchange (PE). In order to determine whether Pentasp an(R) (PES), a synthetic low molecular weight starch solution, might b e an effective substitute, we compared albumin with PES in 12 patients with myasthenia gravis or Guillain-Barre syndrome. STUDY DESIGN AND M ETHODS: Six patients were randomly assigned to receive PES and six to receive albumin as replacement fluid during their course of PE, which consisted of two to five treatments delivered over a maximum of 10 day s. All patients were hospitalized and observed closely. Blood pressure s were recorded every 4 hours and daily measurements were made of hema tologic, coagulation, and immunoglobulin parameters. RESULTS: Individu al exchange volumes were similar in each group (37 ml/kg-range 6-62-in patients receiving albumin vs. 41 ml/kg-range 6-41-in those receiving PES). Changes in immunoglobulin levels and coagulation parameters wer e similar but mild, transient thrombocytopenia was observed in three s ubjects given PES. Total serum protein and albumin levels decreased si gnificantly in patients replaced with PES. Clinically, PES was well to lerated. Hypotension occurred in one patient who developed septic shoc k due to an infected femoral catheter; in another patient, a pre-exist ing pleural effusion was thought to increase slightly. CONCLUSIONS: PE S appears to be a safe replacement fluid for PE, but larger clinical s tudies are required to confirm these findings. (C) 1997 Wiley-Liss, In c.