What replacement fluid should be used during the plasmapheresis procedure?
The choice of replacement fluids includes 5% albumin, fresh-frozen plasma (FFP), and crystalloid (e.g., 0.9% saline, Ringer’s lactate) solutions. Albumin is generally combined 1:1 with 0.9% saline, and does not contain calcium, potassium, coagulation factors, or immunoglobulins. FFP contains complement and coagulation factors and is the replacement fluid of choice in patients with TTP, because the infusion of normal plasma may contribute to the replacement of the deficient plasma factor, ADAMTS-13. Plasma may also be preferable in patients at risk of bleeding, or those requiring intensive therapy, because frequent replacements with albumin solution will eventually result in postplasmapheresis coagulopathy and a net loss of immunoglobulins.
