Caitlin Raymond: The Plasma Chaser in Therapeutic Plasma Exchange
Caitlin Raymond, Assistant Professor of Pathology and Transfusion Medicine at University of Wisconsin-Madison, shared a post on LinkedIn:
“A patient is near the end of a routine plasma exchange. Albumin the whole way through. Then the last 2 units switch to FFP to ‘finish.’
Nothing about the patient changed. Nothing about the math supports it.
I call it the plasma chaser, and it isn’t a treatment. It’s a ritual. Rituals don’t have to work to persist.
- Factor levels can drop 60 percent or more over the course of an exchange. Two units of FFP at the end buys back a handful of percentage points against that.
- If the goal is real coagulation correction, weight based dosing (10 to 15 mL kg) is what moves the needle, not a token switch.
- If the goal is oncotic support, albumin is the tool built for it. FFP is a poor substitute.
- Every unit of FFP is a separate donor exposure: allergic reactions, TRALI, TACO, alloimmunization. That risk doesn’t shrink because it happens at the end.
The fix isn’t complicated. Decide what your replacement fluid is for before the procedure starts, then commit for the whole exchange.
If you can’t say what you’re correcting, you’re not treating the patient. You’re crossing yourself and hoping.
Does your service have a plasma chaser?
What’s the reason people give for it?”
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