The hemostatic balance after plasma-exchange transfusion in myasthenia Gravis.

ABSTRACT

BACKGROUND: To study the effects of plasma-exchange on removal and recovery of haemostatic factors and inhibitors using albumin or PPS as replacement fluid. DESIGN: Prospective, noninterventional study. SETTING: Medical intensive care unit of a university hospital. PATIENTS The study included 11 consecutive patients with Myasthenia Gravis, whose haemostatic parameters were normal before plasma-exchange. INTERVENTIONS: Plasma coagulative factors and inhibitors were studied before at the end of and 24 hours after each exchange. RESULTS: Immediately after exchange plasma coagulation factors and inhibitors evaluated were reduced, except for factor VIII; 24 hours later only fibrinogen was significantly decreased; D-Dimer was not found increased; the platelets, after exchange, were at normal levels. CONCLUSIONS: Our data show a parallel lowering of haemostatic factors and inhibitors after plasmapheresis using material devoid of coagulation factors as replacement, this explains the absence of hemorrhagic or thrombotic complications. So we think that careful monitoring of coagulation during plasma-exchange is not useful.