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7.2.3
Membrane plasma separation (MPS)
Indication
Types of TPE
Extracorporeal blood
circuit and balancing
Plasma filter
Replacement solution
Fresenius Medical Care multiFiltrate IFU-EN-UK 15A-2015
According to the prescribed procedure, the minimum dose of 100 ml/h
substituate / dialysate, which can be set in the paediatric mode of the
device, corresponds to a minimum body surface of the patient of
0.087 m². This value lies significantly below the typical body surface of
an average newborn and usually also permits reasonable treatments for
premature infants. According to the prescribed procedure, the
maximum dose of 1200 ml/h substituate / dialysate, which can be set in
the paediatric mode of the device, corresponds to a maximum body
surface of the patient of 1.04 m², which matches approximately a body
weight of 30 kg. However, it is already possible to change from the
paediatric mode of the device to one of the treatment modes for adults
when treating smaller patients. According to the prescribed procedure,
the minimum dose of 600 ml/h substituate / dialysate, which can be set
with CVVH or CVVHD in the adult's treatment modes, corresponds to a
minimum body surface of the patient of 0.52 m², which matches
approximately a body weight of 11 kg.
Membrane plasma separation (MPS) is a type of therapeutic plasma
exchange (TPE) and is used if pathogenic plasma components can only
be removed with the highly permeable membranes of special plasma
filters due to their size or specific binding to large plasma proteins, such
as albumin.
Autoimmune diseases, such as Guillain-Barré syndrome, are an
example of the group of diseases for which the removal of
autoantibodies by TPE is an accepted therapeutic option.
In some cases, the treatment envisages a replacement of plasma
components by means of infusion.
TPE can be performed by centrifugation or by membrane plasma
separation. The device is designed for membrane plasma separation.
The extracorporeal blood circuit for MPS does not differ significantly
from the CRRT circuit. The balancing circuit is basically comparable to
that of the Post CVVH procedure. To ensure the replacement solution,
e.g., donor plasma, is heated carefully, two heater bags are installed in
series. This minimises the risk of local overheating.
For MPS, filters with a highly permeable membrane are used, which is
permeable to all plasma components, but not to cellular blood
components. These filters are therefore called plasma filters.
In MPS, the plasma is filtered from the blood together with all the
components that need to be removed, and a suitable replacement
solution is infused applying the gravity-controlled balancing method.
As the plasma removed contains colloid osmotically active proteins
such as albumin, replacement solutions containing iso-oncotic colloids
are typically used.
Chapter 7: Functional description
7-11
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