A patient who is subjected to repeated plasmapheresis may become depleted in a number of plasma proteins.


Risk factors for protein depletion:

(1) repeated plasmapheresis with plasma replaced by crystalloid, albumin or small amounts of fresh frozen plasma

(2) pre-existing or concurrent malnutrition

(3) other sources of protein loss (protein losing enteropathy, burns, etc)

(4) increased catabolic state


Laboratory findings:

(1) low serum albumin and total protein

(2) abnormal PT and PTT

(3) low serum immunoglobulins

(4) low oncotic pressure


Clinical consequences:

(1) coagulopathy

(2) edema

(3) immunodeficiency

(4) complications associated with inadequate transport proteins


Plasmapheresis is often done to remove antibodies causing disease. Unfortunately loss of desirable immunoglobulins occurs as well.


Differential diagnosis:

(1) pre-existing coagulopathy

(2) heart failure

(3) immunosuppressive medications


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