Partial colloid starch replacement for therapeutic plasma exchange.

Traditionally protein solutions have been used as the replacement solution of choice during therapeutic plasma exchange (TPE). Treatment protocols vary, but neurology patients, who exhibit autonomic instability, are typically replaced entirely with 5% protein solution. Due to sporadic product shortages and the increasing cost of protein solutions, we evaluated the use of 6% and 3% hetastarch (HES) as partial replacement during TPE. All adult neurology patients with normal liver, heart, and kidney function were evaluated for HES replacement. The first seven patients (33 procedures) received 1000 ml of 6% hetastarch as part of their replacement fluid and the next 42 patients (289 procedures) received 1000 ml of 3% HES as part of their replacement fluid. Three patients crossed over into both groups. Patients were evaluated for signs of peripheral edema, evidence of bleeding, skin rash, and any subjective changes. Total protein albumin, osmolality, PT, and aPTT were measured prior to each procedure in the first five patients in each group. In both groups there was a drop in total protein, but all other lab values returned to normal limits within 48 hours of treatment. One patient reported slight peripheral edema after two procedures. In the 3% HES group the BP and P remained stable in 97.3% (280) procedures. Two patients receiving 6% HES and 1 patient receiving 3% HES complained of severe transient back and head pain during HES infusion. There was no evidence of bleeding or subjective changes. Three percent HES is a safe and cost-effective partial replacement for albumin during TPE.