Hidroxietil-almidón como líquido de reemplazo en aféresis terapéutica: experiencia en una unidad de cuidados intensivos

Abstract

Introduction

Therapeutic apheresis (TA) enables the removal of disease-associated molecules from plasma, thereby halting disease progression. The replacement effluent for TA depends on the type of disease. The most used are albumin (4% or 5%) and fresh plasma. However, synthetic plasma expanders such as hydroxyethyl starch (6%) have been utilized in TA.

Objective

To describe the experience with the use of hydroxyethyl starch (6%) in the intensive care unit (ICU) as the primary replacement effluent.

Materials and methods

A retrospective descriptive study was conducted from October 1, 2014, to December 31, 2020, in an ICU in Cartagena, Colombia, involving patients indicated by a nephrologist to initiate TA according to the guidelines of the American Society for Apheresis (ASFA). Therapeutic apheresis was performed by filtration using the classic multifiltrate technology (Fresenius Medical Care). Plasma volume was calculated using the Kaplan method, and the plasma exchange dose was 1 to 1.5 times the estimated plasma volume, with isovolumetric and iso-oncotic replacement using 6% hydroxyethyl starch, fresh frozen plasma (FFP), and crystalloids.

Results

Of the 22 patients included, 18 received 6% hydroxyethyl starch as the main replacement fluid. The median age was 44 years (32.3-64.5). Patients presented with hypertension (n = 7 [31.8%]) and diabetes mellitus (n = 3 [13.6%]). The main indications for TA were Guillain-Barré syndrome (n = 18 [81.8%]) and myasthenia gravis (n = 18 [81.8%]). Hematological and/or nephrological conditions were recorded as indications for TA in a smaller proportion (n = 4 [18%]). Six percent hydroxyethyl starch was administered to patients with neurological conditions. A total of 101 TA sessions were performed: 87 with 6% hydroxyethyl starch and 14 with fresh frozen plasma (FFP). The safety of TA with 6% hydroxyethyl starch was analyzed using hemoglobin values, platelet count, coagulation profile, and creatinine levels (before and after TA sessions).

Conclusion

The use of HES as a replacement fluid for therapeutic apheresis proved to be safe and may be an alternative to the use of 4% or 5% albumin as a substitution fluid.