How do you choose TPE replacement fluids?

You know that therapeutic plasma exchange (TPE) involves removing plasma from the patient. And, to balance out that removal, the patient receives a replacement fluid or solution. In this article, we share insights on factors that healthcare professionals consider when deciding on the most appropriate replacement fluid for a particular TPE procedure.

Reminder: What is TPE?
TPE helps patients by either removing particular cells or infusing a missing, beneficial component. During a TPE procedure, the patient’s blood is passed through a medical device, such as the Spectra Optia^TM Apheresis System, which separates plasma from other blood components. The plasma is removed, while the other components, along with replacement fluid, are returned to the patient.

What are the replacement fluid options?
For TPE procedures, replacement fluid options include 5% human serum albumin, fresh frozen plasma (FFP), and isotonic crystalloids. Each one has different properties and contents. For example, 5% albumin and FFP contain proteins that might help stabilize blood pressure, while crystalloids, such as saline and lactated Ringer’s, do not contain proteins. Additionally, 5% albumin contains small amounts of citrate, FFP contains significant amounts of citrate, and crystalloids do not contain citrate at all.

How do you choose a replacement fluid?
Healthcare professionals consider replacement fluid properties, like those discussed above, and a combination of patient factors when choosing an appropriate replacement fluid for a TPE procedure, with the patient’s diagnosis the main deciding factor. The American Society for Apheresis (ASFA) Guidelines also provide direction to physicians on what type of replacement fluid is recommended for a specific disease.

Most TPE procedures use 5% albumin or plasma as the prescribed replacement fluid.¹ However, in some cases, the physician may order a combination of replacement fluids. This may be prescribed by the physician for various reasons, including the need to replenish clotting factors for a patient during the exchange.

How do you add replacement fluid information to Spectra Optia?
During a TPE procedure, the type of replacement fluid used influences how the Spectra Optia system manages the anticoagulant (AC) infusion rate. Because different replacement fluids contain different citrate concentrations, it is essential for the operator to update the system with any changes to the replacement fluid during the procedure.

To update the replacement fluid, select the Data menu button, then the Fluid Data menu tab, where you can change the replacement fluid type in the drop-down menu. Finally, select Confirm to acknowledge the new replacement fluid and continue the procedure.

Replacement Fluid Data Screen Shot 1.png

For more information
To learn more about choosing replacement fluids or performing TPE on Spectra Optia, check out these reference tools:

For more helpful training materials or to arrange training for your team, contact your Terumo Blood and Cell Technologies representative.

¹McLeod BC. Therapeutic apheresis: use of human serum albumin, fresh frozen plasma and cryosupernatant plasma in therapeutic plasma exchange. Best Pract Res Cl Ha. March 2006;19(1):157-167. doi: 10.1016/j.beha.2005.01.0004
Spectra Optia^TM is either a registered trademark or trademark of Terumo BCT, Inc. in the United States and/or other countries. See TerumoBCT.com/trademarks for details.