AM20-20: Comparing and Contrasting Centrifuge and Membrane Therapeutic Plasma Exchange

Description

Plasma separation for the purposes of therapeutic plasma exchange (TPE) can be accomplished through the use of a centrifuge or a membrane. Centrifuge TPE is frequently utilized in the United States, particularly among transfusion medicine-based apheresis services. Membrane TPE is also available in the United States and not uncommonly performed among nephrology-based apheresis services on already existing dialysis equipment. In fact, two membranes are FDA approved for membrane TPE in the United States. Regrettably, the literature comparing these two TPE methods is scant, and there is not widespread familiarity with membrane TPE within the greater transfusion medicine community. While an increasing number of nephrologists and nephrology trainees are exposed to membrane TPE, membrane TPE is largely overlooked in most transfusion medicine training, practice, and literature. The goal of this interdisciplinary session is to provide a forum in which transfusion medicine and nephrology practitioners can, in real time, compare these two methods and achieve a greater understanding of the strengths and weaknesses of each method. First, the technical aspects of both centrifuge and membrane TPE will be discussed, including, but not limited to vascular access, anticoagulation, efficiency of plasma removal, properties of the centrifuge or membrane, and replacement fluid. Focus will then be shifted to a review of the literature that attempts to address the important question of whether centrifuge TPE and membrane TPE are clinically equivalent. Opportunities for further research will be discussed, as will strategies by which practitioners of transfusion medicine can become more familiar with membrane TPE and by which practitioners of nephrology can become more familiar with centrifuge TPE.

Learning Objectives:

• Examine the technical aspects of both membrane and centrifuge therapeutic plasma exchange
• Discuss the literature exploring the use of membrane therapeutic plasma exchange and the clinical settings in which is commonly performed
• Compare the strengths and weaknesses of both membrane and centrifuge therapeutic plasma exchange

Speaker(s):

• Dr. Casey N. Gashti, Rush University Medical Center
• Dr. Julie Katz Karp, MD, Thomas Jefferson University Hospital
• Dr. Amber P. Sanchez, University of California San Diego

Disclosures

• Julie Katz Karp, MD : Nothing to disclose
• Casey Gashti : Consultant: NxStage Medical Inc.
• Amber Sanchez : Nothing to disclose