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Chegini A, Moghadami M, Maghary AH. Therapeutic Plasma Exchange in Tehran Between 2011 and 2014. Ther Apher Dial 2019; 24:230-234. [PMID: 31177634 DOI: 10.1111/1744-9987.12864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Abstract
The goal of therapeutic plasma exchange (TPE) is to remove autoantibodies, pathogenic molecules, immune complexes, toxins, high concentration lipoproteins, and pathological proteins. We aimed to present the most common indication of TPE and rate of admission to the intensive care unit. From 2011 to 2014, our retrospective study was conducted including 1069 inpatients from the Tehran Blood Transfusion Center, which was responsible for performing therapeutic apheresis in all 122 hospitals of Tehran. The patients, based on their TPE indication, were classified into five groups: hematological and oncological, neurological, renal, rheumatological diseases, and all the remaining diseases. We performed 6329 procedures of TPE on 1069 inpatients. Of the patients, 479 (44.8%) were male and 590 (55.2%) female. Their age varied from a minimum of 2 years to the maximum of 93 years. Overall, the mean of TPE sessions for each patient was 5.92 ± 3.9; 415 (38.8%) patients were admitted to the intensive care unit (ICU). ASFA categories I/II indications were considered an appropriate request for TPE, and 82.97% (887) of all TPE were suitable. The most frequent categories of TPE indications are as follows: neurological, hematological, and renal diseases. Class I/II indications in the neurological diseases, myasthenia gravis (21.7%), Guillain-Barré disease (21%), and multiple sclerosis (13.3%), were the most prevalent. In the hematological category, thrombotic thrombocytopenic purpura (TTP) (14.1%) was observed to be greater than the other indications. We observed that the most prevalent illnesses are neurological (myasthenia gravis), hematological (TTP), and renal.
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Affiliation(s)
- Azita Chegini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mehran Moghadami
- Apheresis Department, Tehran Blood Transfusion Center, Tehran, Iran
| | - Amir H Maghary
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Korkmaz S, Solmaz Medeni S, Demirkan F, Kalayoglu Besisik S, Altay Dadin S, Akgun Cagliyan G, Kabukcu Hacioglu S, Sari I, Goren Sahin D, Arat M, Dagdas S, Ozet G, Kutlu N, Karaagac Akyol T, Ozcebe OI, Uskudar Teke H, Kiper Unal D, Guner N, Tombak A, Celik H, Bay I, Kiki I, Ozgur G, Erkurt MA, Ozatli D, Meletli O, Demircioglu S, Demir C, Kurtoglu E, Vural F, Tobu M, Karakus A, Ayyildiz O, Dal MS, Afacan Ozturk B, Albayrak M, Ocakci S, Bolaman Z, Sonmez M, Karakus V, Gokmen Sevindik O, Berber I, Dogu MH, Gulturk E, Ulas T, Payzin B, Kuku I, Cagirgan S, Altuntas F. The Turkish experience with therapeutic plasma exchange: A national survey. Transfus Apher Sci 2019; 58:287-292. [DOI: 10.1016/j.transci.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kundrapu S, Datla S, Griffin V, Maitta RW. Adverse events during apheresis: A 10‐year experience at a tertiary academic medical center. J Clin Apher 2019; 34:528-536. [DOI: 10.1002/jca.21706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Sirisha Kundrapu
- Department of Pathology University Hospitals Cleveland Medical Center Cleveland Ohio
- Department of Pathology, Division of Transfusion Medicine Case Western Reserve University School of Medicine Cleveland OH
| | - Sireesha Datla
- Department of Pathology University Hospitals Cleveland Medical Center Cleveland Ohio
| | - Vanessa Griffin
- Department of Pathology University Hospitals Cleveland Medical Center Cleveland Ohio
| | - Robert W. Maitta
- Department of Pathology University Hospitals Cleveland Medical Center Cleveland Ohio
- Department of Pathology, Division of Transfusion Medicine Case Western Reserve University School of Medicine Cleveland OH
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Tiwari AK, Dara RC, Pandey P, Arora D, Rawat G, Raina V. Change in therapeutic apheresis practices: Role of continuing medical education (CME). J Clin Apher 2015; 31:16-21. [DOI: 10.1002/jca.21397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ravi C. Dara
- Department of Transfusion Medicine; Medanta-the Medicity; Gurgaon India
| | - Prashant Pandey
- Department of Transfusion Medicine; Jaypee Hospital; Greater Noida India
| | - Dinesh Arora
- Department of Transfusion Medicine; Medanta-the Medicity; Gurgaon India
| | - Ganesh Rawat
- Department of Transfusion Medicine; Medanta-the Medicity; Gurgaon India
| | - Vimarsh Raina
- Laboratory Services and Transfusion Medicine; Medanta-the Medicity; Gurgaon India
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Eichbaum Q, Smid WM, Crookes R, Naim N, Mendrone A, Marques JFC, Marques MB. Apheresis in developing countries around the World. J Clin Apher 2014; 30:238-46. [PMID: 25346394 DOI: 10.1002/jca.21368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022]
Abstract
At the combined American Society for Apheresis (ASFA) Annual Meeting/World Apheresis Association (WAA) Congress in San Francisco, California, in April of 2014, the opening session highlighted the status of apheresis outside of the United States. The organizers invited physicians active in apheresis in countries not usually represented at such international gatherings to give them a forum to share their experiences, challenges, and expectations in their respective countries with regard to both donor and therapeutic apheresis. Apheresis technology is expensive as well as technically and medically demanding, and low and median income countries have different experiences to share with the rest of the world. Apheresis procedures also require resources taken for granted in the developed world, such as reliable electrical power, that can be unpredictable in parts of the developing world. On the other hand, it was obvious that there are significant disparities in access to apheresis within the same country (such as in Brazil), as well as between neighboring nations in Africa and South America. A common trend in the presentations from Brazil, Indonesia, Malaysia, Nigeria, and South Africa, was the need for more and better physicians and practitioners' training in the indications of the various apheresis modalities and patient oversight during the procedures. As ASFA and WAA continue to work together, and globalization allows for increased knowledge-sharing, improved access to apheresis procedures performed by qualified personnel with safety and high-quality standards will be increasingly available.
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Affiliation(s)
- Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - W Martin Smid
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Robert Crookes
- Independent Transfusion Medicine Consultant, South Africa
| | - Norris Naim
- Consultant Pathology (Haematology) and Quality Manager, National Blood Centre, Ministry of Health Malaysia, Kuala Lampur, Malaysia
| | - Alfredo Mendrone
- Fundação Pró-Sangue Hemocentro de São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Marisa B Marques
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Morales Borges RH, Nieves GC, Martínez MR, Ramos RV, Pedraza Otero LI, Vargas CN, Pedraza GO, Jiménez JJM. Therapeutic aphaeresis: Experience in Puerto Rico. Transfus Apher Sci 2014; 50:473-8. [DOI: 10.1016/j.transci.2014.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/22/2014] [Accepted: 02/24/2014] [Indexed: 11/25/2022]
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Haque A, Sher G, Hoda M, Moiz B. Feasibility of pediatric plasma apheresis in intensive care settings. Ther Apher Dial 2014; 18:497-501. [PMID: 24674133 DOI: 10.1111/1744-9987.12173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Therapeutic plasma apheresis or exchange (TPE) in the pediatric population is technically challenging. Moreover, there is generally an apprehension in using TPE in children compared to adults. Recently, usage of TPE has evolved and is now being used in heterogenous clinical conditions. Its usefulness is classified by the American Society for Apheresis (ASFA) into various categories ranging from I to IV. The objective of this paper was to review the procedure in context of clinical indications, complications and outcomes in children. For this purpose, we retrospectively reviewed all TPE procedures performed on inpatients of 3 to 16 years of age during a 6-year period (2007-2012). A total of 130 procedures were performed on 28 patients (M : F ratio of 1:1) with median age (range) of 8.8 (4-16) years. All procedures were done using the continuous cell-separator centrifugal method. Due to organ dysfunctions, the majority of procedures (N = 26 of 28 or 92% patients) were performed in the pediatric intensive care unit. Twenty-three, four and one patient belonged to ASFA categories I, II and III, respectively. The most common indications were neurological disorders (N = 13 or 46.4%), comprised of Guillain-Barré syndrome (N = 10) and myasthenia gravis (N = 3). Hematological disorders (N = 10 or 35.7%) including thrombotic thrombocytopenic purpura-hemolytic uremic syndrome were a close second. Complete recovery was seen in 23 patients (84%). Trivial adverse effects were observed in 18/130 (13.8%) procedures. Major complications including cardiac arrest, hypotension and transfusion-related acute lung injury were observed in 5/130 or 3.8% of procedures. However, there was no procedure-related death though five patients died during treatment due to underlying pathology. In conclusion, TPE is a safe and effective option in sick children for appropriate indications. An experienced staff with sound procedural skills is imperative for successful therapy.
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Affiliation(s)
- Anwarul Haque
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Córdoba JP, Larrarte C, Ruiz A. Is anticoagulation required in plasmapheresis? A University Hospital Experience in Bogota, Colombia. Transfus Apher Sci 2013; 48:301-5. [DOI: 10.1016/j.transci.2013.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Sharma RR, Saluja K, Jain A, Dhawan HK, Thakral B, Marwaha N. Scope and application of therapeutic apheresis: Experience from a tertiary care hospital in North India. Transfus Apher Sci 2011; 45:239-45. [PMID: 22036963 DOI: 10.1016/j.transci.2011.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 08/22/2011] [Accepted: 09/23/2011] [Indexed: 01/04/2023]
Abstract
BACKGROUND We present here our experience with therapeutic apheresis (TA) performed for various indications, clinical response and complications in a tertiary care center over last 10 years. STUDY DESIGN AND METHODS Present study is a retrospective analysis of 492 TA procedures performed for 125 patients from January 2000 to December 2009. For each patient: age, gender, weight, clinical indication, pre-procedure hematological profile and ionized calcium levels were recorded. For every procedure following parameters were analyzed: type of venous access (central/peripheral), volume of blood and plasma processed, amount of anticoagulant used, procedure duration, blood flow rate, type of replacement fluid given, response to therapy and adverse reactions. RESULTS Of 492 TA procedures, 68.8% were performed for neurology, 20.8% hematology-oncology, 9.6% renal and 0.8% for rheumatology patients. Therapeutic plasma exchanges (n=464; 94.3%) and therapeutic cytapheresis (n=28; 6.7%) were performed in 113 and 12 patients, respectively. Majority of patients belonged to ASFA category I and II (n=124; 99.2%). The overall response rate was 84%, with encouraging response in TTP (100%), aHUS (81.8%) and in neurological disorders (88.4%). Adverse events were reported in 52.8% of patients in 14.83% of procedures. CONCLUSION Our results of TPE in neurological disorders and in atypical hemolytic uremic syndrome are encouraging and it is a cost effective alternative to IvIg in neurological disorders. Currently, there is a need for establishment of an Indian apheresis registry to understand the scenario of TA across the country and in the expansion of appropriate and applicable indications for TA in our setting.
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Malchesky PS, Koo AP, Skibinski CI, Hadsell AT, Rybicki LA. Apheresis Technologies and Clinical Applications: The 2007 International Apheresis Registry. Ther Apher Dial 2010; 14:52-73. [DOI: 10.1111/j.1744-9987.2009.00716.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malchesky PS, Koo AP, Roberson GA, Hadsell AT, Rybicki LA. Apheresis Technologies and Clinical Applications: The 2005 International Apheresis Registry. Ther Apher Dial 2007; 11:341-62. [PMID: 17845394 DOI: 10.1111/j.1744-9987.2007.00507.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The developments in apheresis technologies and techniques and their clinical applications worldwide are technologically, sociologically, and economically motivated. In past apheresis surveys the statistics have highlighted both the differences by geographic region in clinical practice and in the types of technologies utilized. While a national view of apheresis is very important, an international view may be more representative overall of this therapeutic modality than national results that are highly dependent on the local economics and the available technologies. These regional differences have provided a basis for scientific and clinical assessment of these apheresis technologies and their clinical outcomes, and have impacted the marketing and business developments of new technologies worldwide. The results of the International Apheresis Registry for 2005 reporting from 22 centers on 5 continents are presented. The survey collected data exclusively via a secure internet website on 1133 patients for a total of 6501 treatments. Unlike our prior registries, information on stem cell infusions was gathered. Information gathered included patient demographics, medical history, treatment diagnoses, treatment specifics (type, methodology, access type, anticoagulants, drugs, and equipment usage), side-effects, clinical response, and payment provider. As in the prior International Apheresis Registries for 1983, 2000, and 2002 the survey results highlight the regional differences in apheresis usage and treatment methodologies, indicating that an international overview of apheresis may be more representative of the impact of this therapeutic modality.
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Affiliation(s)
- Paul S Malchesky
- The International Center for Artificial Organs and Transplantation, Painesville, OH, USA.
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Yavasoglu I, Kadikoylu G, Akyol A, Bolaman Z. Therapeutic apheresis: Results from a single center in Turkey. Transfus Apher Sci 2007; 36:249-53. [PMID: 17556022 DOI: 10.1016/j.transci.2007.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 01/12/2007] [Accepted: 02/12/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes. AIM We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006. METHODS A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis. RESULTS While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain. CONCLUSION TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.
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Affiliation(s)
- Irfan Yavasoglu
- Adnan Menderes University Medical Faculty, Divisions of Hematology, 09100 Aydin, Turkey.
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