I agree with you Prof Jordan.

Asabry brought up that he uses Plasmafiltration. Any feelings here that Plasmapheresis is more efficient than Plasmafiltration. As a method, Plasmapheresis is riskier, and Plasmafiltration is more comfortably combined with the often required dialysis at the same time. Still, I have always had the feeling that the pore size in Plasmafiltration and also the clogging up of the pores, especially in polysulfon kidneys has always been an issue.

In our center, we only use plasmapharesis; I can ask our pharesing physician to comment.

I would love to hear the opinion of your plasmapheresis specialist on this. I guess I have a soft spot somewhere for plasmafiltration as it gives us, as nephrologists the chance to treat our patients. Plasmapheresis is usually done by haematologists.

Johan

In addition to the RCT by Clark and the CAG group, there have been other studies disputing the usefullness of plasmapheresis in this setting (Cserti et al, Transfusion 2007, 47:511-514). However, this may not be the end of the story. A quick scan of Pubmed will reveal increased interest in this topic and calls for further studies precisely because the RCT was flawed. It is also true that hematologists appear reluctant to refer their patients (or rather support nephrologists in their referral) for reasons of: fear of VTE related to the line (patients with MM are at higher risk for VTE than other patients) and fear of infections (patients with MM are immunodeficient and predisposed to infections). So their argument is that there is little evidence of benefit and a real possibility of harm. Just curious Jordan, what did your patient's hematologist say? Katerina