Preoperative management of XXXX with therapeutic plasma exchange: A case report and literature review.

@entity1 @entity21728 @entity548 @entity245 @entity929 @entity715
UNASSIGNED: @entity1 with @entity21728 may have @entity548 complications during surgery. Because @entity548 severity and factor levels correlate poorly, factor replacement needs to be personalized based on @entity548 history and type of procedure. We report a 65-year-old male with @entity21728 (7 IU  dL(-1) ) who presented before scheduled hip arthroplasty. He had a history of total hip arthroplasty complicated by @entity548 , @entity245 and prosthesis removal, despite receiving prophylactic treatment with plasma infusion. For the current surgery a factor XI >= 50 IU  dL(-1) level was targeted. The calculated plasma infusion needed to achieve this goal was 3100 mL (14 U). Because of concerns about circulatory overload and inability to achieve target by simple infusion, prophylactic treatment with therapeutic plasma exchange (TPE) was requested. TPE was performed the morning before the surgery, using 100% plasma as replacement fluid (3912 mL of plasma), and a positive fluid balance of 631 mL. Factor XI activity level was 51 IU  dL(-1) immediately post TPE. The @entity1 received daily infusions of 3 U (    660 mL) of plasma to maintain a factor XI level of 30 IU  dL(-1) until post-operative day 7. @entity929 was given during the surgery and until post-operative day 10. There were no @entity548 or @entity715 complications. CONCLUSION: TPE was effective in increasing factor XI levels; it was well tolerated and did not result in circulatory overload. TPE can be considered when therapeutic factor levels cannot be achieved by simple plasma infusion, or when circulatory overload is a concern. J. Clin. Apheresis, 2015.    2015 Wiley Periodicals, Inc.
