Therapeutic Plasma Exchange: Indications and Outcomes. Single-Center Registry (original) (raw)
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Hemostasis management and therapeutic plasma exchange: Results of a practice survey
Journal of clinical apheresis, 2018
Patients undergoing therapeutic plasma exchange (TPE) may present with risks for hemorrhage or thrombosis. Use of replacement fluids devoid of coagulation factors will decrease factor levels and platelet levels. There are no established guidelines for hemostasis management in these situations. A survey to evaluate current hemostasis management practice during TPE was conducted using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 107 respondents. Descriptive analysis was performed with results reported as the number and frequency (%) of respondents to each question. Apheresis Medicine physicians, alone (59.4%) or jointly with the requesting provider (29.2%), choose the replacement fluid. Based on a theoretical patient case receiving five TPEs approximately every other day, the percent of respondents who would use albumin with or without normal saline was 94.7% with no ...
Dicle Medical Journal, 2021
The aim of the study was to evaluate the outcomes and characteristics of therapeutic plasma exchange (TPE) and double filtration plasmapheresis (DFPP) in one center. Method: The data of cases treated with therapeutic plasmapheresis at the university hospital between 2007 and 2012 were retrospectively analyzed. 445 TPE and 391 DFPP sessions were done totally. Results: In the 5.5 years, in 116 cases 445 TPE and 391 DFPP sessions were done. The mean age was 46.61±16.83 years. There were 49 female and 67 male patients. Guillain-Barre syndrome (8.6%) was the commonly encountered indication for neurological diseases, glomerulonephritis (25%) was the leading indication for the renal-related diseases. Skin involvement due to diabetes mellitus (13.8%) and Pemphigus Vulgaris (5.2%) were the dermatological diseases. Complication rates were similar between DFPP and TPE sessions (p= 0.411). Conclusion: TPE and DFPP are safe and vital membrane separation techniques used as a treatment for a wide spectrum of diseases. These treatments can be safely done in hemodialysis units intensive care units and DFPP should be considered for the therapy refractory neurological diseases.
Therapeutic Plasma Exchange in Tanta University Hospitals, Single Center Experience
The Medical Journal of Cairo University, 2019
Background: Therapeutic Plasma Exchange (TPE) is effective therapeutic procedure in treating diverse diseases. Aim of Study: To evaluate the outcomes of TPE in different diseases in our department. Patients and Methods: Retrospective study of patients referred for TPE during last five years period. We reviewed the demographic, clinical indications, number of sessions, volume of exchanged plasma, patient response and complications during or after the procedure and descriptive statisticalanalysis was performed. Results: The study included 109 patients recorded during the last 5 years period. The indications for TPE were Gullian-Baree in 28 patients with response in (21/28 pateints), thrombotic microangiopathy in 27 patients with response in (19/27) patients, SLE in 22 patients with response in (16/22), Cryoglobinemia in 12 patients with response in (10/12), RPGN in 5 patients with response in (4/5) patients, hyperviscosity in 6 patients, mythenia gravis in 4 patients, renal transplantation in 3 patients, dermatomyocitis in one patient and autoimmune hemolytic anemia in one patient with complete response in all patients of these later diseases. The main complications of the procedure were muscle cramps induced by hypocalcemia (n=10, 9%), allergic reactions (n=9, 8%), hypotension (n=7, 6%), fever (n=4, 3.6%), loss of consciousness (n=2, 1.8%), convulsions (n=2, 1.8%), catheter related hematoma (n=1, 0.9%), bleeding from AV fistula (n=1, 0.9%). Conclusion: Our experience in therapeutic plasma exchange showed favorable results in different immunological and non-immunological diseases.
Therapeutic Plasma Exchange Outcomes in Cairo University Hospitals: 6 Years Experience
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 2018
Therapeutic plasma exchange is used in treating different immunological and non-immunological diseases. We analyzed the outcome of 308 patients treated by 1783 membrane plasma exchange sessions from January 2011 until January 2017 at Cairo University Hospital. Thrombotic microangiopathies were the commonest indication [73 (23.7%) patients] with response in 63/73 patients (86.3%), followed by systemic vasculitis with pulmonary-renal involvement [40(13%) patients] with recovery in 32/40 patients (80.0%), Guillain-Barré syndrome [39(12.7%) patients] with recovery in 30/39 patients (76.9%), myasthenia gravis [31(10.1%) patients] with response in 26/31 patients (83.9%), and catastrophic antiphospholipid syndrome [28(9.1%) patients] with recovery in only 6/28 patients (21.4%). Complications included hypotension [276/1783 (15.5%) sessions], hypocalcemia [26/308 (8.5%) patients], and 37/308 (12%) patients died. Sepsis caused mortality in 29/37 (78.4%) of patients. In conclusion, our therape...
Complications of Therapeutic Plasma Exchange: Experience With 4857 Treatments
Therapeutic Apheresis and Dialysis, 2005
Plasma exchange (PE) is a technique of extracorporeal blood purification which removes large molecular weight substances from plasma. The Department of Dialysis, Zagreb University Hospital Center's database, which includes data on 509 patients, or 4857 PE treatments, was retrospectively analyzed to test the safety of PE. A total of 231 adverse reactions were recorded (4.75% of treatments). The most common complications were paresthesias (2.7%), hematoma at the puncture site (2.4%), clotting (1.7%), mild to moderate allergic reactions (urticaria; 1.6%) and bleeding (0.06%). True anaphylactoid reactions were recorded in five procedures. The incidence of severe, potentially life-threatening adverse reactions was 0.12%. The prophylactic use of calcium and potassium was responsible for a low incidence of electrolyte disturbances. There was no lethal outcome associated with PE. When carried out by experienced staff, PE is a relatively safe procedure. The use of fresh frozen plasma is associated with a higher rate of adverse reactions.
Con: High-volume plasma exchange application in nephrology and beyond
Nephrology Dialysis Transplantation, 2017
The rationale behind the use of plasma exchange (PE) includes the removal of autoantibodies and other plasma constituents, such as cytokines, complement components, neutrophil extracellular traps, and microparticles, and the substitution of missing plasma factors. The more established indications are associated with the beneficial effects of PE of reducing the plasma levels of pathogenic agents, although the efficiency of this process decreases during the course of the procedure as the substituted replacement fluid dilutes the patient's original plasma. Thus, removal can be more effective by repeating sessions rather than continuing so-called high-volume PE. The kinetics of PE efficiency have been extensively investigated and exchange between body compartments of substances to be removed is of considerable importance.
Therapeutic plasma exchange in nephrology. Where it applies?
Transfusion and Apheresis Science, 2019
Plasma exchange had been proposed to treat many kidney diseases. A few controlled studies, observational studies, and mechanistic evidence have specified the better indications, which are thrombotic microangiopathies, kidney transplantation and ANCAassociated vasculitides. Plasma removal can be realized by filtration, centrifugation, or immunoadsorption, with differences in efficacy, but these also impact on volume load and anticoagulation in patients with renal failure.
Therapeutic plasma exchange in an intensive care unit (ICU): A 10-year, single-center experience
Transfusion and Apheresis Science, 2011
Therapeutic plasma exchange (TPE) is a blood purification method that effectively allows for the removal of waste substances by separating out plasma from other components of blood and the removed plasma is replaced with solutions such as albumin and/or plasma, or crystalloid/colloid solutions. Plasma exchange therapies are becoming increasingly essential, being used in daily practice in critical care settings for various indications, either as a first-line therapeutic intervention or as an adjunct to conventional therapies. This retrospective clinical study analyzes 10-year therapeutic plasma exchange activity experience in an 18-bed ICU at a tertiary care university hospital with a large, critically-ill patient population. Medical records of 1188 plasma exchange procedures on 329 patients with different diagnoses admitted from January 2000 to July 2010 were evaluated. The aim of the study was to determine the TPE indications and outcomes of the patients who underwent TPE in the ICU with conventional therapy. The secondary endpoints were to determine the differences between different patient groups (septic vs. non-septic indications) in terms of adverse events and procedural differences.
Hemostasis testing and therapeutic plasma exchange: Results of a practice survey
Journal of clinical apheresis, 2018
Performing therapeutic plasma exchange (TPE) with albumin replacement decreases coagulation factor and platelet levels. No defined guidelines exist regarding laboratory testing to assess hemostasis in patients undergoing TPE. A survey to evaluate hemostasis testing with TPE was distributed using online survey software. One response per institution was analyzed based on a hierarchical algorithm, excluding membrane filtration users, resulting in a maximum of 120 respondents per question. Descriptive analysis was performed with results reported as the number and/or frequency (%) of respondents to each question. The practices represented vary by institution type, number of apheresis procedures per year, and performance of TPE on children. Prior to TPE planned with albumin replacement, many respondents obtain laboratory studies for almost all patients (54.9% outpatients and 68.7% inpatients); however, some do not routinely obtain laboratory studies (9.7% outpatients and 4.4% inpatients)....