Spectra Optia apheresis system: experience with secondary plasma devices

Performing clinical procedures and optimal management of Spectra Optia in combination with secondary plasma devices (SPDs) have not been described in the literature. To contribute to this topic, we examined 300 data log files from patients treated with the Spectra Optia from November 2015 until October 2016. Of these 300 procedures, 149 secondary plasma treatments were conducted in 13 patients (76 immunoadsorption [IA] and 73 lipoprotein apheresis [LA]). Nine patients had IA due to transplantation and autoimmune diseases. Four patients were treated with LA after heart transplantation. Of the procedures, 62% were performed using peripheral venous access, even in patients with a low inlet blood flow. A central catheter was required only in 15% cases, and an arteriovenous fistula in 23% of the procedures. Anticoagulation management differed in both procedures. The LA procedures required a higher amount of citrate as they were performed using only citrate. The IA procedures required less citrate because a mixture of citrate and heparin was used. We did not observe clotting or bleeding, regardless of heparin use. Due to strict calcium management, no patient showed signs of hypocalcemia. Despite our apheresis management, four procedures had to be canceled preliminarily due to patient complications. The targeted substances could be reduced significantly: lipoprotein (a) (Lpa) level by 68% (76%–45%), low-density lipoprotein-cholesterol by 57% (64%–37%), and IgG from 6.6 (1.09–21.0) to 2.61 (0.33–14.7) g/l. The Cobe could be replaced by the Optia system effectively. The Optia has a high plasma extraction efficiency, which allows SPD procedures with peripheral venous access and moderate inlet flow rates. Keywords: adverse events, anticoagulation, peripher venous access, lipoprotein apheresis, immunoadsorption