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References & Formulas

TPE PRESCRIPTION

To prescribe TPE  the amount of plasma to be exchanged must be determined in relation to the patient’s estimated plasma volume (EPV). This calculator uses this formula to calculate the  EPV  from the patient’s weight and hematocrit:

 

Estimated plasma volume (EPV) = (weight x 65) x (1- hematocrit/100) 

Volume to be exchanged=  EPV x number of plasma exchanges 


Kaplan AA. Therapeutic plasma exchange: a technical and operational review. J Clin Apher. 2013;28(1):3-10.

PMID: 23420589.

Cervantes CE, Bloch EM, Sperati CJ. Therapeutic Plasma Exchange: Core Curriculum 2023. Am J Kidney Dis. 2023 Apr;81(4):475-492.

PMID: 36775691

Macromolecule Kinetics

ONE SESSION KINETICS:

The amount of plasma to be exchanged in order to achieve a given reduction in pretreatment macromolecule levels can be determined by applying first-order kinetics using the following formulas:


Macromolecule reduction ratio = (1 − (Math.exp(−number of plasma exchanges))) × 100

Macromolecule residual proportion = (Math.exp(−number of plasma exchanges)) × 100
 

This applies only to a single session and only to intravascular pretreatment level reductions.


TOTAL TREATMENT IgG KINETICS:

A preformed IgG pool with a 21-day half-life will be reduced after a number of specific TPE treatments. This calculator assumes no IgG synthesis, an IgG distribution of 45% intravascular and 55% extravascular, and complete equilibrium of IgG between TPE treatments.

This calculator does not apply to other macromolecules, including IgG3.


Kaplan AA. Therapeutic plasma exchange: a technical and operational review. J Clin Apher. 2013;28(1):3-10.

PMID: 23420589. 


Albumin Calculator

The number of albumin vials required to prepare a replacement solution is practical information for an accurate prescription. This calculator uses simple formulas to determine the vials needed based on the initial albumin concentration, the preparation volume, and the desired final albumin percentage.


Number of 25% vials  = Initial concentration  x  ( preparationVolume / 100) / 12.5

Number of 20% vials =  Initial concentration x ( preparationVolume / 100) / 10

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Adequator is not a substitute for clinical or technical reasoning. No medical decisions should be made based solely on this program’s results.



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Disclaimer: Extracorporeal therapies are complex and require a full understanding of technical and clinical considerations. Adequator is not a substitute for clinical or technical reasoning. No medical decision should be made solely on this program’s results.