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Abstract: SA-PO1105

Removal of sFLT-1 and PlGF with Plasmapheresis in Pregnancy

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

  • Sivagnanam, Milani, Rush University Medical Center, Chicago, Illinois, United States
  • Wei, Huiting, Rush University Medical Center, Chicago, Illinois, United States
  • Khan, Samia Qamar, Rush University Medical Center, Chicago, Illinois, United States
  • Gupta, Vineet, Rush University Medical Center, Chicago, Illinois, United States
  • Latef, Mamoor Shahid, Rush University Medical Center, Chicago, Illinois, United States
  • Gashti, Casey N., Rush University Medical Center, Chicago, Illinois, United States
  • Whittier, William Luke, Rush University Medical Center, Chicago, Illinois, United States
Background

Preeclampsia is characterized by HTN and proteinuria >20 weeks of gestation with glomerular endotheliosis thought to be due to an imbalance of angiogenesis (placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFLT-1)). sFLT-1 levels are higher near the end of normal pregnancies; however, sFLT-1 levels increase earlier and to higher concentrations and inhibit PlGF in preeclampsia.
Removal of sFLT-1 using selective apheresis in early preeclampsia prolongs time to delivery. The effect of membrane-based plasma exchange (mTPE) on sFLT-1 and PlGF levels are not known.

Methods

A 33 y/o 35 week pregnant patient presented with a concern for HELLP vs. TTP. Empiric daily mTPE sessions with FFP replacement were initiated until her ADAMTS13 returned at 42%. Her clinical status gradually improved after delivery of the placenta and a viable baby.
Serum samples were obtained before, immediately following, and two hours after one mTPE session. We examined sFLT-1 and PlGF concentration of these samples as well as in the effluent in duplicate.

Results

sFLT-1 was immediately reduced by 86% with mTPE (64.94 ng/ml to 9.17 ng/mL, p=0.03) and rebounded to 15.88 ng/mL two hours after (p=0.02), 4 times less than pre-mTPE values. Effluent sFLT-1 was 38.46 ng/mL. PlGF was immediately reduced by 48% (42.40 pg/ml to 21.89 pg/ml, p=0.13) and rebounded to pre-mTPE values two hours after (42.7 pg/mL, p=0.07). Effluent PlGF level was 42.4 pg/ml. The reduction in the sFLT-1/PLGF ratio was 1.53 to 0.42 (73% reduction) (p<0.01) (Fig 1).

Conclusion

mTPE removed sFLT-1 from the serum at nearly a 4:1 ratio compared to PlGF in pregnancy, and PlGF rebounded to pre-mTPE values within two hours. This ratio reduction is theoretically favorable to improve the angiogenic imbalance in preeclampsia and suggests that mTPE may have a role as therapy for preeclampsia in the future.

Removal of sFLT-1 and sFLT-1/PlGF ratio in pregnancy with mTPE. *p<0.05