5 de março de 2013

Artigo recomendado: Perioperative Therapeutic Plasmapheresis

Sloan C. Youngblood, Yi Deng, Alice Chen, Charles D. Collard

Anesthesiology 2013; 118:722-8, Youngblood et al.

Numerous disease states, including those often encountered in the perioperative setting, are mediated by excessive, deficient, or abnormal blood components. Although systemic immunosuppression has been used successfully to treat many of these, significant side effects and refractory disease often persist. Therapeutic apheresis facilitates the removal and replacement of both humoral and cellular blood elements and has found a unique niche in the treatment of these disorders.

In current practice, the terms “plasmapheresis” and “therapeutic plasma exchange” are often used interchangeably. However, plasma exchange takes the plasmapheresis procedure one step further. Plasma is separated from whole blood and discarded, whereas erythrocytes, leukocytes, and platelets are returned to the patient along with replacement fluid in a volume equal to that of the removed plasma. Perioperative plasmapheresis poses several challenges for the anesthesiologist, including alterations in intravascular volume, serum electrolytes, the coagulation cascade, and drug pharmacokinetics. We now review the plasmapheresis procedure and its implications for perioperative care.

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