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Boada M, Kiprov D, Anaya F, López OL, Núñez L, Olazarán J, Lima J, Grifols C, Barceló M, Rohe R, Prieto-Fernández C, Szczepiorkowski ZM, Páez A. Feasibility, safety, and tolerability of two modalities of plasma exchange with albumin replacement to treat elderly patients with Alzheimer's disease in the AMBAR study. J Clin Apher 2023; 38:45-54. [PMID: 36305459 PMCID: PMC10092802 DOI: 10.1002/jca.22026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the Alzheimer Management by Albumin Replacement (AMBAR) study, mild-to-moderate Alzheimer's disease (AD) patients were treated with a plasma exchange (PE) program. Feasibility and safety of PE in this specific population are poorly understood and were analyzed in detail in this study. METHODS Qualified patients were treated with 6 weeks of weekly conventional therapeutic plasma exchange (TPE) with albumin replacement followed by monthly low-volume plasma exchange (LVPE) for 12 months. The patients were divided into four groups: placebo (sham PE treatment), low-albumin (20 g), low-albumin + intravenous immunoglobulin (IVIG) (10 g), and high-albumin (40 g) + IVIG (20 g). Adverse events (AEs) were recorded and analyzed for all PE treatment groups and PE modalities. RESULTS PE procedure-related AEs were more common in the active treatment groups (16.9% out of 1283 TPE and 12.5% out of 2203 LVPE were associated with at least one AE, a similar rate than in other PE indications) than in the placebo group (0.7% out of 1223 sham PE). Percentage of procedures with at least one AEs was higher with central venous access compared to peripheral venous access in all three active treatment groups (20.1% vs 13.1%, respectively). CONCLUSION The TPE and LVPE procedures used in the AMBAR study on mild-to-moderate AD population were as safe and feasible as in other therapeutic applications of PE or routine plasmapheresis.
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Affiliation(s)
- Mercè Boada
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | - Fernando Anaya
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura Núñez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Memory Disorders Clinic, HM Hospitales, Madrid, Spain
| | - José Lima
- American Red Cross Southern Blood Services Region, Atlanta, Georgia, USA
| | | | | | - Regina Rohe
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | | | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Antonio Páez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
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Kohli R, Geneen LJ, Brunskill SJ, Doree C, Estcourt L, Chee SEJ, Al‐Bader R, Sin WYC, MacCallum P, Green L. Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used. J Clin Apher 2022; 37:438-448. [PMID: 35726507 PMCID: PMC9795884 DOI: 10.1002/jca.21996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/19/2022] [Accepted: 06/01/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this systematic scoping review is to identify and categorize the outcome measures that have been reported in clinical studies, where therapeutic plasma exchange (TPE) has been used as an intervention in any clinical settings, excluding thrombotic thrombocytopenic purpura (TTP). METHODS We searched electronic databases using a predefined search strategy from inception to October 9, 2020. Two reviewers independently screened and extracted data. RESULTS We included 42 studies (37 RCTs and 5 prospective cohort studies) grouped into six main categories (neurology, immunology, renal, rheumatology, hematology, and dermatology). Primary outcomes were defined in eight studies (19%, 8/42) and were categorized as efficacy (five studies) or patient reported outcomes (three studies). A power calculation was reported in six studies (75%, 6/8): five neurology studies (mainly patient reported outcomes) and a single immunological study (efficacy outcome). Disease-specific efficacy outcomes were dependent on the clinical setting of the population receiving TPE. Most of the trials (43%, 18/42) were undertaken in patients with neurology conditions where clear, disease-specific, clinical outcome measures were used, including neurological disability scales (11/18, 61%), change in neurological examination (9/18, 50%), and functional improvement scores (7/18, 39%). For other conditions, the reporting of disease-specific outcomes was poorly reported. Safety outcomes were mainly related to replacement fluid type rather than being disease-specific. The most common outcome reported was hypotension (19%, 8/42), and this was primarily in patients exchanged with albumin. CONCLUSION Future clinical studies to determine which fluid replacement option is most efficacious and safe should use disease-specific outcomes, as a trial in one therapeutic area may not necessarily translate to another therapeutic area. Patient reported outcomes are not universally reported for all disease areas. Safety measures focused primarily on fluid safety.
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Affiliation(s)
- Ruchika Kohli
- Wolfson Institute of Population Health, Queen Mary University of LondonLondon
| | - Louise J. Geneen
- Systematic Review Initiative, National Health Service Blood and TransplantOxfordUK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Susan J. Brunskill
- Systematic Review Initiative, National Health Service Blood and TransplantOxfordUK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Carolyn Doree
- Systematic Review Initiative, National Health Service Blood and TransplantOxfordUK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Lise Estcourt
- Systematic Review Initiative, National Health Service Blood and TransplantOxfordUK
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | | | - Peter MacCallum
- Wolfson Institute of Population Health, Queen Mary University of LondonLondon
- Barts Health NHS TrustLondonUK
| | - Laura Green
- Barts Health NHS TrustLondonUK
- National Health Service Blood and TransplantLondonUK
- Blizard Institute, Queen Mary University of LondonLondonUK
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Das J, Chauhan VD, Mills D, Johal NJ, Tan M, Matthews R, Keh R, Lilleker JB, Gosal D, Sharaf N. Therapeutic plasma exchange in neurological disorders: Experience from a tertiary neuroscience centre. Transfus Apher Sci 2019; 58:102654. [PMID: 31648858 DOI: 10.1016/j.transci.2019.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/13/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
Therapeutic plasma exchange (TPE) involves the extracorporeal separation of plasma from the cellular components of blood with replacement fluid, such as human albumin or fresh frozen plasma. A number of studies across the world revealed that more than one third of TPE procedures were performed for neurological disorders. Myasthenia gravis (MG), Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) were the most frequently cited indications for TPE, followed by multiple sclerosis (MS). However, treatments of these conditions have evolved over the years and it is likely that this has impacted on clinical practice. Here we present our experience of using TPE to treat neurological disorders. We reviewed the medical records of all 63 patients who received 349 procedures over 70 therapeutic cycles between 2012 and 2015 in a tertiary neurology centre. In total only 2 patients with GBS and MG were treated with TPE. The commonest indication was voltage gated potassium channel (VGKC) complex antibody associated disorders followed by CIDP and MS. There were 11 patients with limbic encephalitis. Nine of them had antibodies against VGKC complex and two had N-methyl-D-aspartate (NMDA) receptor antibodies. Sixty four percent of patients with limbic encephalitis and overall 78% of patients responded to TPE. The complication rate associated with this procedure was 8.6 per 100 therapeutic cycle. There was no treatment related mortality. We observed a change in indications of TPE compared to historical studies. It was less frequently used to treated GBS and MG. It was found to be safe and effective.
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Affiliation(s)
- Joyutpal Das
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
| | - Vanisha D Chauhan
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.
| | - Daniel Mills
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Nicholas J Johal
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Maevis Tan
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Rachael Matthews
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Ryan Keh
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - James B Lilleker
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK
| | - David Gosal
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Nazar Sharaf
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
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Abstract
Intravenous immunoglobulin (IVIg) is used in the treatment of autoimmune diseases, including immune-mediated central and peripheral nervous system disorders. This article will review the indications, proposed mechanism of actions, and administration of immunoglobulin treatment in various neuropathies, neuromuscular junction disorders, and myopathies. IVIg may have more than one mechanism of action to alter the pathogenesis of underlying neuromuscular disease. IVIg treatment has been used as a first-line treatment in Guillain-Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and second-line off-label treatment in medically refractory cases of polymyositis, dermatomyositis, and myasthenia gravis. IVIg is a well-tolerated and effective treatment for these neuromuscular diseases. With this review article, we hope to increase clinicians' awareness of the indications and efficiencies of IVIg in a broad spectrum of neuromuscular diseases.
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Affiliation(s)
- Ahmet Z Burakgazi
- Department of Internal Medicine, Neuroscience Section, Virginia Tech Carilion School of Medicine, Carilion Clinic Neurology, Roanoke, VA
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5
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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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Schmidt JJ, Asper F, Einecke G, Eden G, Hafer C, Kielstein JT. Therapeutic plasma exchange in a tertiary care center: 185 patients undergoing 912 treatments - a one-year retrospective analysis. BMC Nephrol 2018; 19:12. [PMID: 29334938 PMCID: PMC5769505 DOI: 10.1186/s12882-017-0803-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is increasingly used throughout the world. Although the procedure itself is fairly standardized, it is yet unknown how the underlying disease entities influence the key coordinates of the treatment. METHODS Retrospective chart review. The treatment indications were clustered into four categories. Data are presented as median and interquartile (25-75%) range [IQR]. RESULTS Within 1 year, 912 TPE treatments were performed in 185 patients (90 female, 48.6%). The distribution of the treatment numbers to the pre-specified disease categories were as follows: transplantation (35.7%), neurology (31.9%), vasculitis and immunological disease (17.3%), and others including thrombotic microangiopathy (8.1%), critical care related diseases (5.4%), hematology [multiple myeloma] (1.1%), and endocrine disorders (0.5%). The calculated plasma volume was significantly higher in patients with vasculitis and immunological diseases (3984 [3433-4439] ml) as compared to patients treated for transplant related indications (3194 [2545-3658] ml; p = 0.0003) and neurological diseases (3058 [2533-3359] ml; p < 0.0001). This was mainly due to the differences in the hematocrit which was 30.5 [27.0-33.6] % in the vasculitis/immunological disease patients and 40.2 [37.5-42.9] % in the neurological patients; p < 0.0001. Interestingly, treatment time using a membrane based technology was significantly longer than TPE using a centrifugal device 135.0 [125.0-140.0] min vs. 120.0 [112.5-135.0] min. Furthermore, the relative exchanged plasma volume was significantly lower in the treatment of vasculitis and immunological diseases as compared to treatments of transplant related indications and neurological diseases. CONCLUSION Patients with low hematocrit and high body weight do not receive the minimum recommended dose of exchange volume. Centrifugal TPE allowed faster plasma exchange than membrane TPE.
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Affiliation(s)
- Julius J. Schmidt
- Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Firas Asper
- Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Gunilla Einecke
- Department of Nephrology and Hypertension, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Gabriele Eden
- Medical Clinic V | Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Carsten Hafer
- Medical Clinic V | Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Jan T. Kielstein
- Medical Clinic V | Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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7
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Pagano MB, Harmon C, Cooling L, Connelly-Smith L, Mann SA, Pham HP, Marques MB, Schlueter AJ, Case R, King KE, Cataife G, Wu Y, Wong ECC, Winters JL. Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity. Transfusion 2016; 56:2848-2856. [DOI: 10.1111/trf.13795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/17/2016] [Accepted: 07/17/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Monica B. Pagano
- Department of Laboratory Medicine; University of Washington; Seattle Washington
| | - Charles Harmon
- Department of Pathology; University of Michigan; Ann Arbor Michigan
| | - Laura Cooling
- Department of Pathology; University of Michigan; Ann Arbor Michigan
| | | | - Steven A. Mann
- University of Alabama School of Medicine; Birmingham Alabama
| | - Huy P. Pham
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama
| | - Marisa B. Marques
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama
| | | | - Rosemary Case
- Division of Transfusion Medicine; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Karen E. King
- Division of Transfusion Medicine; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Guido Cataife
- Health Division; IMPAQ International; Columbia Maryland
| | - Yanyun Wu
- Bloodworks Northwest; Seattle Washington
| | - Edward C. C. Wong
- Division of Laboratory Medicine, Departments of Pediatrics and Pathology, Children's National Medical Center; George Washington School of Medicine and Health Sciences; Washington DC
| | - Jeffrey L. Winters
- Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine; Mayo Clinic; Rochester Minnesota
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8
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Therapeutic plasmapheresis in geriatric patients: favorable results. Transfus Apher Sci 2014; 51:64-7. [PMID: 25457004 DOI: 10.1016/j.transci.2014.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/24/2014] [Accepted: 10/07/2014] [Indexed: 11/22/2022]
Abstract
Therapeutic plasma exchange is generally a tolerable procedure, although several complications should be considered. Since geriatric population has been growing worldwide, the aim of this study was to retrospectively analyze 4709 TPE data from 981 geriatric procedures (20.8%) and to compare them with 3728 non-geriatric procedures (79.2%). The most common indications for TPE in both groups were sepsis/adult respiratory distress syndrome and multiple organ dysfunction. In geriatric patient group, contrary to expectations of aggravation, complication rate was statistically similar with non-geriatric group (P > 0.05). Therefore, TPE appeared to be a safe procedure in geriatric patients when performed by experienced practitioners.
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Therapeutic plasma exchange in treatment of neuroimmunologic disorders: Review of 92 cases. Transfus Apher Sci 2013; 49:174-80. [DOI: 10.1016/j.transci.2013.02.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 12/19/2012] [Accepted: 02/13/2013] [Indexed: 11/18/2022]
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10
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Sauer M, Altrichter J, Mencke T, Klöhr S, Thomsen M, Kreutzer HJ, Nöldge-Schomburg G, Mitzner SR. Role of Different Replacement Fluids During Extracorporeal Treatment in a Pig Model of Sepsis. Ther Apher Dial 2012; 17:84-92. [DOI: 10.1111/j.1744-9987.2012.01103.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Brunetta Gavranić B, Bašić-Jukić N, Kes P. Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia. Ther Apher Dial 2011; 15:587-92. [DOI: 10.1111/j.1744-9987.2011.00986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Yilmaz AA, Can OS, Oral M, Unal N, Ayyildiz E, Ilhan O, Tulunay M. Therapeutic plasma exchange in an intensive care unit (ICU): a 10-year, single-center experience. Transfus Apher Sci 2011; 45:161-6. [PMID: 21835700 DOI: 10.1016/j.transci.2011.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- Ali Abbas Yilmaz
- Ankara University, Faculty of Medicine, Anaesthesiology and Intensive Care, Ibn-i Sina Hospital, 06100 Ankara, Turkey.
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Adjuvant therapeutic plasma exchange in liver failure: assessments of clinical and laboratory parameters. J Clin Gastroenterol 2008; 42:517-21. [PMID: 18344887 DOI: 10.1097/mcg.0b013e31815878ff] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) seems to be an effective approach for clearing toxins, immune-mediated antigens, and other particles from the circulation. The aim of this study was to analyze the positive effects of TPE on clinical and biochemical parameters of liver failure. PATIENTS AND METHODS Between January 2001 and March 31, 2005 individuals (men/women, 17/14; median age, 42.7+/-15.8 y) with acute and chronic liver failure who underwent a total of 113 TPEs (median session 3.7) were retrospectively reviewed. TPE was performed using the Fresenius AS-TEC 204 cell separator (Fresenius AG, Germany). The indication for TPE was severe coagulopathy (prothrombin time >20 s), severe hepatic encephalopathy, hyperbilirubinemia, and candidacy for liver transplantation. All patients were examined before and immediately after the last TPE session. RESULTS When compared with baseline, there was significant improvement in hepatic encephalopathy stage (from median score 3.0 to 1.0, P=0.001), serum prothrombin time (from median 26.0 to 20.0 s, P=0.003), aminotransferases (P<0.001), and total bilirubin levels (from median 35.0 to 23.3 mg/dL, P<0.001) after TPE. Thirteen of the thirty-one individuals (41.9%) died in the hospital. The mean follow-up period of 18 survival patients was 35.9+/-5.6 months and 10 of those survived (55.6%, 10/18). No serious adverse effect of TPE was observed in any of the patients during or after completion of TPE. Only 6 patients experienced minor transfusion reactions. CONCLUSIONS TPE seems to be effective in improving hepatic encephalopathy stage and liver tests in individuals with acute and chronic liver failure. The data suggest that TPE is safe and tolerable in such individuals, however, overall survival remains poor despite TPE.
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Grapsa E, Triantafyllou N, Rombos A, Lagouranis A, Dimopoulos MA. Therapeutic Plasma Exchange Combined With Immunomodulating Agents in Secondary Progressive Multiple Sclerosis Patients. Ther Apher Dial 2008; 12:105-8. [DOI: 10.1111/j.1744-9987.2008.00554.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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