Intensive
plasma exchange can transiently alter the
hemostatic system. However, the effect of serial
double filtration plasmapheresis (
DFP) on the
hemostatic system has not been adequately described. In this study, we sought to characterize the
hemostatic effects of
DFP in 32
myasthenia gravis patients who received one course of
DFP treatment for five consecutive sessions within 10 days. Platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and serum levels of
albumin,
globulin,
cholesterol, and
fibrinogen were measured before and after the course of
DFP. Patients were divided into mild hypofibrinogenemia (MH) and severe hypofibrinogenemia (SH) groups based on post-
plasmapheresis residual levels of
fibrinogen above or below 70 mg/dl. The baseline
fibrinogen level was significantly lower in the SH group (P < 0.01). After five sessions of
DFP, the
fibrinogen level was reduced to below 70 mg/dl in 14 patients (44%). The percentage of excessive prolongation of PT or PTT was significantly higher in the SH group. The SH group also had higher reduction rates of
globulin and
cholesterol (P < 0.05). Oozing in the punctured site of the
central venous catheter occurred in 6 out of 26 patients, with four cases in the MH group and two in the SH group. There was no difference in the overall incidence of
bleeding complications between the two groups. Only one episode of clinically overt
bleeding occurred during the study after a large-bore femoral
catheter was removed soon after the patient had received five consecutive daily treatments. The
bleeding stopped after transfusion of 6 units of fresh frozen plasma. In conclusion, despite the obvious reduction of
fibrinogen level and the modest decrease in platelet count after an intensive course of
DFP treatment, the low incidence of clinically overt
bleeding confirmed the safety of
DFP.