{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:47:52Z","timestamp":1776386872115,"version":"3.51.2"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T00:00:00Z","timestamp":1607472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recent data suggests an association between blood hyperviscosity and both propensity for thrombosis and disease severity in patients with COVID\u201019. This raises the possibility that increased viscosity may contribute to endothelial damage and multiorgan failure in COVID\u201019, and that therapeutic plasma exchange (TPE) to decrease viscosity may improve patient outcomes.<\/jats:p><jats:p>Here we sought to share our experience using TPE in the first 6 patients treated for COVID\u201019\u2010associated hyperviscosity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>Six critically ill COVID\u201019 patients with plasma viscosity levels ranging from 2.6 to 4.2 centipoise (cP; normal range, 1.4\u20101.8\u2009cP) underwent daily TPE for 2\u20103 treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TPE decreased plasma viscosity in all six patients (Pre\u2010TPE median 3.75\u2009cP, range 2.6\u20104.2\u2009cP; Post\u2010TPE median 1.6\u2009cP, range 1.5\u20101.9\u2009cP). TPE also decreased fibrinogen levels in all five patients for whom results were available (Pre\u2010TPE median 739\u2009mg\/dL, range 601\u20101188\u2009mg\/dL; Post\u2010TPE median 359\u2009mg\/dL, range 235\u2010461\u2009mg\/dL); D\u2010dimer levels in all six patients (Pre\u2010TPE median 5921\u2009ng\/mL, range 1134\u201060\u2009000\u2009ng\/mL; Post\u2010TPE median 4893\u2009ng\/mL, range 620\u20107518\u2009ng\/mL); and CRP levels in five of six patients (Pre\u2010TPE median 292\u2009mg\/L, range 136\u2010329\u2009mg\/L; Post\u2010TPE median 84\u2009mg\/L, range 31\u2010211\u2009mg\/L). While the two sickest patients died, significant improvement in clinical status was observed in four of six patients shortly after TPE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This series demonstrates the utility of TPE to rapidly correct increased blood viscosity in patients with COVID\u201019\u2010associated hyperviscosity. Large randomized trials are needed to determine whether TPE may improve clinical outcomes for patients with COVID\u201019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.16218","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T21:00:38Z","timestamp":1606251638000},"page":"1029-1034","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Therapeutic plasma exchange for <scp>COVID\u201019\u2010associated<\/scp> hyperviscosity"],"prefix":"10.1111","volume":"61","author":[{"given":"Alexander D.","family":"Truong","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory Critical Care Center Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara C.","family":"Auld","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory Critical Care Center Emory University School of Medicine  Atlanta Georgia USA"},{"name":"Department of Epidemiology Emory University Rollins School of Public Health  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas A.","family":"Barker","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Emory St. Joseph\u02bcs Hospital  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Friend","sequence":"additional","affiliation":[{"name":"Department of Hematology and Medical Oncology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. Thanushi","family":"Wynn","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory Critical Care Center Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Cobb","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Medicine Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roman M.","family":"Sniecinski","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christin\u2010Lauren","family":"Tanksley","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory Critical Care Center Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek M.","family":"Polly","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Emory University Hospital Midtown  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manila","family":"Gaddh","sequence":"additional","affiliation":[{"name":"Department of Hematology and Medical Oncology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Connor","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory Critical Care Center Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirotomo","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4909-7168","authenticated-orcid":false,"given":"H. Clifford","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Kempton","sequence":"additional","affiliation":[{"name":"Department of Hematology and Medical Oncology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannette","family":"Guarner","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Duncan","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassandra D.","family":"Josephson","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D.","family":"Roback","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1130-9551","authenticated-orcid":false,"given":"Sean R.","family":"Stowell","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies Emory University School of 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