Continuous venovenous hemofiltration/hemodiafiltration (CVVH/D) is commonly
used to provide renal replacement therapy for critically ill patients who
are hemodynamically unstable. Occasionally, the addition of plasmapheresis
therapy is necessary for some conditions, including immune-mediated acute r
enal failure, sepsis, fulminant hepatic failure, and thrombotic thrombocyto
penic purpura/hemolytic uremic syndrome. Most tertiary care facilities prov
ide centrifugation plasmapheresis instead of membrane plasmapheresis, becau
se of the requirement for both therapeutic plasma exchange and pheresis of
cellular blood products. We report a new technique where centrifugation pla
smapheresis and CVVHD (P-CVVHD) are combined and used concurrently. Blood f
rom the patient was concurrently filtered utilizing a Hospal BSM 22 machine
with a Multiflow 60 hemofilter and a Cobe Spectra continuous cell separato
r in a parallel configuration. P-CVVHD is technically possible and can be u
sed for long periods of time with limited risks. There may be advantages to
P-CVVHD compared with discontinuous combined CVVH/D and plasmapheresis the
rapy.