Fluid replacement practices in plasma exchange when FFP alone is not indicated

A Medical Director in the Northeast writes that he is curious about the fluid replacement practices in plasma exchange when FFP alone is not indicated. He writes that one facility he worked at used 5% albumin on a 1:1 basis with supplements of 4 mEq/L K⁺ and 2 mEq/L Ca⁺² as an isovolemic replacement for plasma. Another facility he worked at used 5% albumin for all but 1.5L of the procedure, and 3 L of normal saline to replace the other 1.5 L, (the extra volume of NS was intended to leave the patient isovolemic after the crystalloid redistributes into extravascular volume), but checked the patient's K⁺ and Ca⁺² pre-procedure, mid-procedure, and post-procedure. He currently sees some practitioners using 5% albumin for 80% of the replacement volume and NS at a 1:1 ratio for the other 20%. Compared with a 2:1 NS replacement ratio, this may leave the patient with a net loss of intravascular volume after redistribution (as this is roughly equivalent to using 4% albumin). He inquires what other practices are out there and how the practices compare with respect to the patient's final intravascular volume.

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