Although
hypotension is a potential complication for all procedures involving
extracorporeal circulation, including
plasmapheresis, the effects of serial
double-filtration plasmapheresis (
DFP) on hemodynamic status have rarely been reported. Blood pressure (BP) and pulse rate (PR) were prospectively monitored at 30-minute intervals (baseline, M30, M60, M90, and Ml20) during procedures for 20
myasthenia gravis patients who underwent one course of five consecutive
DFP treatments on alternate days, with hemodynamic parameters recorded and analyzed for all sessions. To evaluate the hemodynamic influence of
protein loss resulting from serial
DFP treatment, additional analysis of
serum protein levels including
albumin and
globulin was conducted before and after the entire course of treatment. Longitudinal analysis on the systolic BP (SBP) changes over five sessions revealed that the SBP at baseline and at M30 dropped significantly during the third and fourth sessions, in comparison to the first (P < 0.05). By contrast, SBP at M120 rose significantly (P < 0.05) after the second session of treatment. A similar trend was revealed for the diastolic BP (DBP) with a significant fall recorded at baseline and at M30 for the fourth session. The PR did not differ significantly during consecutive
DFP treatments.
Globulin removal rates were correlated significantly with falls in SBP (r(2) = 0.250, P = 0.048) and DBP (r(2) = 0.405, P = 0.008). However, analogous
albumin removal rate was not correlated with these hemodynamic parameters. In conclusion, our results confirm that
hypoproteinemia is an important factor for contributing to unstable hemodynamics during serial
DFP.