Caitlin Raymond: The Unmeasured Risks of Consecutive Daily TPE
Caitlin Raymond, Assistant Professor of Pathology and Transfusion Medicine at University of Wisconsin-Madison, shared a post on LinkedIn about her recent article, published in Transfusion, adding:
“My letter to the editor was just published in Transfusion, responding to a study on consecutive daily therapeutic plasma exchange (TPE) using albumin-only replacement fluid.
The original paper found serious bleeding is rare in well-screened patients – a solid and useful finding.
But two things weren’t addressed, and I think they matter:
- Efficacy was assumed, not measured. TPE clears the intravascular space, but substances like IgG take up to 48 hours to re-equilibrate from extravascular tissue. Daily procedures may be hitting the same pool repeatedly before that re-equilibration happens – which could mean less total antibody removed, not more efficient removal.
- Drug removal wasn’t measured either. Most outpatients in the study were kidney transplant patients on calcineurin inhibitors. No drug levels were checked, and the safety window was capped at 72 hours – too short to catch effects on graft outcomes that might play out over months.
Efficient doesn’t automatically mean equally effective. Before consecutive daily TPE becomes standard outside crisis settings, I think we owe patients and their teams direct data on both fronts.”
Title: Beyond bleeding: Unstudied questions of efficacy and drug removal in consecutive daily therapeutic plasma exchange
Author: Caitlin Raymond
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