CICM SAQ 2010.1 Q14
Questions
With respect to plasma exchange therapy:
- (a) What are the physical principles of plasma exchange therapy?
- (b) What substances can plasma exchange effectively remove?
- (c) List 5 acute conditions where therapeutic plasma exchange is indicated.
- (d) List 4 common complications of this therapy, excluding catheter-related complications
Answers
Answer and interpretation
(a) What are the physical principles of plasma exchange therapy?
- Separation of plasma from blood cells by centrifugation or membrane filtration
- Reinfusion of cells plus autologous plasma or another replacement solution eg albumin
- Removes large molecular weight substances
(b) What substances can plasma exchange effectively remove?
- Pathogenic auto-antibodies
- Immune complexes
- Cryoglobulins
- Myeloma light chains
- Endotoxin
- Cholesterol-containing lipoproteins /triglycerides
(c) List 5 acute conditions where therapeutic plasma exchange is indicated.
- Myasthenic Crisis
- Goodpasture’s Syndrome with pulmonary haemorrhage
- Hyperviscosity syndromes
— Cryoglobulinaemia
— Paraproteinaemia
— Waldenstrom’s Macroglobulinaemia - Wegener’s Granulomatosis with pulmonary haemorrhage
- Guillain-Barre Syndrome/Acute Inflammatory Demyelinating Polyradiculopathy
- Antiphospholipid Antibody Syndrome
- HELLP syndrome
- Multiple sclerosis
- HIV-related neuropathy
- SLE
- Pemphigus
- Paraneoplastic syndromes
- Rapidly progressive glomerulonephritis
- Renal transplant rejection
- Coagulation inhibitors
- Auto-immune haemolytic anaemia
- DIC
- Overwhelming sepsis syndromes eg meningococcaemia
- Reye’s syndrome
- Paraquat poisoning
(d) List 4 common complications of this therapy, excluding catheter-related complications
- Hypotension due to excess fluid removal +/ inadequate volume replacement
- Citrate-induced hypocalcaemia
- Anaphylactic/transfusion reactions to fresh frozen plasma replacement solution
- Coagulation abnormalities due to removal of clotting factors not replaced when albumin replacement used.
- Removal of useful immunoglobulins and complement which can in theory lead to an immunodeficient state.
- Drug removal – especially drugs with high protein-binding and low volume of distribution. Potential problems in the diseases in which therapeutic plasma exchange is used are cyclophosphamide and azathioprine.
- Hypothermia
- Pyrogenic reactions
- Anaemia
- Thrombocytopenia
- Hepatitis
- Vasovagal reactions
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
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