الفهرس 
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Abstract
T
herapeutic plasma exchange (TPE) is an extracorporeal technique that involves separating a large volume of a patient’s plasma from the cellular components of the blood and replacing it with appropriate fluids. In patients with conditions that are induced and/or exacerbated by pathologic factors and toxins circulating in the plasma, TPE can help eliminate symptoms or prevent damage to the organs or systems involved.
As such, TPE is often used to modulate the level of circulating antibodies, antigen-antibody complexes, complement components, cytokines, abnormal plasma proteins, cholesterol-containing lipoproteins, plasma-bound toxins and drugs. Alternatively, TPE can be used to replace a deficient factor in the plasma, such as von Willebrand cleaving factor, or complement factors to treat thrombotic microangiopathies such as thrombotic thrombocytopenic purpura. TPE can be used either as a standalone treatment or as an adjunct to conventional therapy.
Two different plasma separation techniques exist: centrifugal separation (cTPE) and membrane separation (mTPE). The 2 techniques use different physical principles, but both are capable of effectively separating plasma substances from whole blood and delivering replacement with plasma or albumin.
During mTPE, blood plasma is separated from the cellular components using a filter that prevents the passage of cellular components and enables whole plasma removal. An anticoagulant, usually heparin, is added to the blood before it is pumped through the filter.
During cTPE, centrifugation separates incoming whole blood into plasma, red blood cell, and white blood cell components. An anticoagulant, usually citrate, is added prior to centrifugation. In both procedures, the remaining cell-rich blood is mixed with a replacement fluid (e.g., albumin or fresh frozen plasma) and returned to the patient to prevent hypovolaemia.
This study aimed to compare between the two methods of plasma exchange “centrifugal therapeutic plasma exchange and membrane therapeutic plasma exchange as regard efficacy and tolerability.
It was prospective observational study done in Ain Shams university hospitals (Eldemerdash and Ain Shams university specialized hospital) including 40 patients divided into 2 groups: group A: 20 patients indicated for plasma exchange used membrane method. group B: 20 patients indicated for plasma exchange used centrifugation method.
Our study included 26 females (12 in cTPE and 14 in mTPE) and 14 males (8 in cTPE and 6 in mTPE) with mean age 40.9 ± 20.11 in cTPE and 32.4 ± 8.61 In mTPE. There were no significant differences between the two groups in age, sex, or indications for TPE.
Our study demonstrated a statistically significant difference in use of replacement fluid between the centrifugation and membrane plasma exchange groups (p=0.008). The centrifugation group used fresh frozen plasma (FFP) for 65% of cases and albumin fluid for 35% of cases, while the membrane group used FFP replacement fluid exclusively in all 20 (100%) cases and no albumin. The centrifugation group had shorter preparation and priming times but longer procedure time. The membrane method had a shorter procedure time. Plasma removal efficiency did not differ significantly. This suggests both methods can achieve similar treatment efficacy. Post-procedure hemoglobin was lower in the centrifugation group. Both methods significantly reduced hemoglobin and hematocrit versus baseline. Platelet counts were unchanged. Using albumin, removal efficiency is significant in both IgG (55.3%) and fibrinogen (44.5%). The anticoagulation methods used differed significantly between the centrifugation and membrane plasma exchange groups (p<0.001).
The centrifugation group used sodium citrate anticoagulation exclusively in all 20 (100%) cases, while the membrane group used heparin anticoagulation exclusively in all 20 (100%) cases.
CONCLUSION
• Centrifugation TPE had shorter preparation time, while membrane TPE processed greater volumes per session, but total treatment times were reasonable for both.
• Centrifugation and membrane based TPE achieved similar plasma removal efficiencies. Both methods appeared effective in depleting IgG and fibrinogen and were associated only with minor transient declines in hemoglobin and hematocrit.
• Overall, both centrifugation and membrane filtration TPE represent suitable therapeutic options in clinical practice. The choice between the two methods may depend on factors such as patient characteristics, availability of replacement fluids, and institutional preferences.
RECOMMENDATIONS
• Further studies with larger sample sizes are needed to validate our findings and explore potential factors influencing treatment outcomes.
• Comparative studies evaluating the long-term efficacy and safety of cTPE and mTPE methods are warranted.
• Assessing patient satisfaction and quality of life measures after plasma exchange using different methods could provide valuable insights.
• We recommend further studies to differentiate between the two modalities as regard removal efficiency of IgG and Fibrinogen to be done on large sample size.