Therapeutic plasma exchange in patients with acute on chronic liver failure and severe coagulation disorder: a case series

Background Bleeding complications with unsuccessful conventional stabilization are common in patients with acute on chronic liver failure (ACLF). A therapeutic plasma exchange (TPE), in which the recipient's plasma is replaced with healthy donor plasma, could be a beneficial procedure for these patients. In our single center case series, we examined the effect of TPE on coagulation parameters and the amount of transfusion products needed before and after TPE.

Study design and methods Inclusion of patients with ACLF and severe coagulation disorder. ROTEM analysis, coagulation parameters and the amount of transfusion products were compared before and after TPE.

Results 11 patients were included. While hemoglobin and platelet count were similar before and after TPE, both INR and aPTT were improved significantly (INR: 3.3 (2.5-7) vs. 1.8 (1.5-2.1), p-value<0.001, aPTT: 172 (122-180) s vs. 81 (56-90) s, p-value 0.005). In ROTEM analysis, a significant improvement in clotting time was achieved in EXTEM, INTEM and FIBTEM. The need for transfusion of platelet concentrates, PCC and fibrinogen was significantly lower after TPE (platelet concentrates: 1.5 (1-2) vs. 0 (0-0), p-value 0.002, PCC: 3000 (1200-6200) I.U. vs. 0 (0-1500) I.U., p-value 0.0047, fibrinogen: 6 (2-9) g vs. 2 (0.75-3.25) g, p-value 0.01).

Discussion Blood plasma replacement by TPE could be an efficient option to stabilize coagulation in patients with ACLF and severe coagulation disorder. TPE can reduce the amount of required transfusion products, which could lead to stabilization of pro- and anti-coagulant factors in addition to a reduction in health care costs.

Publication History

Article published online:
20 January 2025