PARTIAL COLLOID STARCH REPLACEMENT FOR THERAPEUTIC PLASMA-EXCHANGE

Traditionally protein solutions have been used as the replacement solu tion of choice during therapeutic plasma exchange (TPE). Treatment pro tocols vary, but neurology patients, who exhibit autonomic instability , are typically replaced entirely with 5% protein solution. Due to spo radic product shortages and the increasing cost of protein solutions, we evaluated the use of 6% and 3% hetastarch (HES) as partial replacem ent during TPE. All adult neurology patients with normal liver, heart, and kidney function were evaluated for HES replacement. The first sev en patients (33 procedures) received 1000 ml of 6% hetastarch as part of their replacement fluid and the next 42 patients (289 procedures) r eceived 1,000 ml of 3% HES as part of their replacement fluid. Three p atients crossed over into both groups. Patients were evaluated for sig ns of peripheral edema, evidence of bleeding, skin rash, and any subje ctive changes. Total protein, albumin, osmolality, PT, and aPTT were m easured prior to each procedure in the first five patients in each gro up. In both groups there was a drop in total protein, but all other la b values returned to normal limits within 48 hours of treatment. One p atient reported slight peripheral edema after two procedures. In the 3 % HES group the BP and P remained stable in 97.3% (280) procedures. Tw o patients receiving 6% HES and 1 patient receiving 3% HES complained of severe transient back and head pain during HES infusion. There was no evidence of bleeding or subjective changes. Three percent HES is a safe and cost-effective partial replacement for albumin during TPE. (C ) 1997 Wiley-Liss, Inc.