ROLE OF REPLACEMENT FLUIDS IN THE IMMEDIATE COMPLICATIONS OF PLASMA-EXCHANGE

Objective: Comparison of side effects (fever shivering and/or allergic reactions, collapse, symptomatic hypocalcaemia) of the different subs titution fluids used during therapeutical plasmapheresis. Design: Mult icentric retrospective comparative study designed to ex plore the side effects due to the replacements fluids (albumin alone or associated w ith dextran 40, modified fluid gelatin, hydroxyethyl starch), and to d etermine the best combination in patients undergoing plasmapheresis. P atients: 46,895 procedures were performed on 5,167 patients between 19 90 and 1994. The analysis concerns 33,962 sessions, divided into two g roups (group 1: 21.079 sessions from 1990 to 1992 comparing albumin al one versus combined albumin-macromolecules and the different combinati ons among these, group 2: 12 883 sessions in 1993-1994 comparing album in alone versus albumin-hydroxyethyl starch). Because of the diversity of the products used, 13,029 sessions were not studied because groups of small sample sizes were formed. Measurements and results: In group 1, the comparison of albumin + macromolecules with albumin alone, sho ws the best haemodynamic tolerance. lower frequency of fever shivering and/or allergic reactions in the albumin alone subgroup. On the other hand, hypocalcaemia is significantly higher in this subgroup. The com binations albumin + dextran 40 (but after hapten inhibition) and album in + hydroxyethyl starch are equivalent. Albumin + modified fluid gela tin is the combination presenting the highest incidence in terms of al lergic manifestations. Ln group 2, albumin + hydroxyethyl starch versu s albumin alone, the former is preferable in terms of the three side e ffects studied. Conclusion: The results of this study show a combinati on of albumin 4%-hydroxyethyl starch to replace plasma during plasma e xchange to be the method presenting the lowest morbidity and the best cost/effectiveness ratio.