Adverse reactions associated with mobile therapeutic apheresis:Analysis of 17,940 procedures

Kiprov, D; Golden, Patricia; Rohe, Regina; Smith, Sheila A.; Hofmann, Jan; Hunnicutt, John A.

doi:10.1002/jca.1024

Cited by 48 publications

(39 citation statements)

References 12 publications

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“…W publikacjach opisujących powikłania tych zabiegów podkreśla się, że chorzy z wyjściowo znacznie obciążającym wywiadem chorobowym, zwłaszcza wymagający wentylacji mechanicznej i podaży amin presyjnych, znamiennie częściej prezentują objawy niepożądane podczas plazmaferezy [11,13,14]. W przedstawianej pracy wszyscy chorzy, u których zastosowano leczniczą wymianę osocza, byli w ciężkim stanie klinicznym, wymagali leczenia na OIT, a pomimo to metoda ta okazała się skuteczna u 91% chorych, przyczyniając się do ustępowania objawów choroby podstawowej.…”

Section: Dyskusjaunclassified

“…Znacznie częściej występują mniej istotne reakcje i objawy, takie jak pokrzywka, świąd skóry, parestezje oraz bóle koń-czyn, skurcze mięśni, zawroty głowy, nudności, wymioty, przejściowy wzrost ciepłoty ciała, dreszcze, drgawki, bóle głowy, bóle w klatce piersiowej. Uwzględniając wszystkie możliwe zdarzenia, łącznie z izolowanymi odchyleniami od wartości referencyjnych w wynikach badań laboratoryjnych, z których najczęstsze to: spadek stężenia hemoglobiny, trombocytopenia, hipokaliemia, hipokalcemia oraz spadek stężenia fibrynogenu [9], łączna częstość występowania powikłań szacowana jest na 25-40% [10,11]. Bezpieczeństwo wykonywania zabiegów w znacznym stopniu zależy od doświadczenia personelu medycznego oraz zaawansowania procesu chorobowego.…”

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Powikłania u chorych leczonych metodą plazmaferezy na oddziale intensywnej terapii

Szczeklik¹,

Wawrzycka²,

Włudarczyk³

et al. 2013

Anaesthesiol Intensive Ther

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Background. Plasmapheresis is one of the methods of extracorporeal blood purification involving the removal of inflammatory mediators and antibodies. The procedure is used in a variety of ailments, including autoimmune diseases. The aim of the present study was to analyse the incidence of plasmapheresis-related complications in patients treated in the intensive care unit (ICU). Methods. The analysis involved 370 plasmapheresis procedures in 54 patients. The data were collected from patients` medical records, including procedure protocols. Results. The most common diseases treated with plasmapheresis included: myasthenia gravis (33.3%), Guillain-Barré syndrome (14%), Lyell's syndrome (9.3%), systemic lupus erythematosus (7.4%), and thrombotic thromcytopenic purpura (7.4%). The adverse side effects observed most frequently during plasma filtration were decreases in arterial blood pressure (8.4% of all procedures), arrhythmias (3.5%), sensations of cold with temporarily elevated temperature and paresthesias (1.1%, each). In most cases, the symptoms were mild and transient. Severe and life-threatening episodes, i.e. shock, drops in arterial blood pressure requiring catecholamines administration, persistent arrhythmias and haemolysis, developed in 2.16% of procedures. Conclusions. Plasmapheresis can be considered a relatively safe method of treatment of ICU patients. Continuous observation and proper monitoring of patients provided by highly trained medical personnel are essential for its safety.

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Section: Dyskusjaunclassified

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Powikłania u chorych leczonych metodą plazmaferezy na oddziale intensywnej terapii

Szczeklik¹,

Wawrzycka²,

Włudarczyk³

et al. 2013

Anaesthesiol Intensive Ther

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“…She had a prolonged hospitalization, evolving to death from sepsis that occurred five months after PE. Kiprov et al 24 found a mortality rate of 0.006% from two large mobile apheresis services. In a survey of seven years PE in Mexico, the mortality rate was 0.2% 26 .…”

Section: Resultsmentioning

confidence: 98%

“…Anticoagulation with sodium citrate solution was responsible for 3% of side effects in all PE procedures 24 , like perioral tingling, trembling, dizziness and hypotension 24,25 . Hypocalcemia resulted in mild paresthesias and tremor in seven of our patients.Vasovagal attack with concomitant hypotension, true hypovolemia or fluid overload may also be complications of PE 25 .…”

Section: Resultsmentioning

confidence: 99%

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Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Carandina-Maffeis

Nucci

Marques

et al. 2004

Arq. Neuro-Psiquiatr.

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-We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215).The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.KEY WORDS: plasmapheresis, myasthenia gravis, therapeutics, acceptance, complications. Plasmaférese no tratamento da miastenia grave: estudo retrospectivo de 26 pacientes RESUMO -Analisamos a experiência do Hospital das Clínicas da Unicamp com plasmaferese: (PF) na miastania grave (MG). 17,8 % do total dos casos de MG submeteu-se a PF, 26 casos, 19 mulheres e sete homens. A idade média de início da MG foi 28 anos (extremos 11 e 69). O menor déficit clínico foi IIb (O & G) e IIIa (MGFA).A PF foi indicada no pré-operatório de timectomia em um caso e em sete devido a crise miastênica. Em 18 casos, com MG generalizada e sintomas bulbares ou com exacerbação de déficit prévio, a PF foi indicada como intervenção aguda. Em dois pacientes desse grupo ela foi indicada também em regime crônico de ciclos mensais. Os 26 pacientes submeteram-se a 44 ciclos e a 171 sessões de PF. O número médio de sessões em cada ciclo foi 3,9 (DP ± 1,4); mediana de 5, extremos 2 e 6. O tempo médio de cada sessão foi 106,5 minutos (DP ± 35,2); mediana de 100,5 (extremos 55 e 215).O volume médio de plasma trocado em cada sessão foi 2396 ml (DP ± 561); mediana 2225 (extremos 1512 e 4500). Efeitos colaterais foram reversíveis: hipotensão (sete casos), tremor ou parestesias leves (sete casos). Taxas de infecção e mortalidade devido a PF foram zero. A totalidade dos pacientes teve benefícios imediatos a cada ciclo de PF e usualmente receberam prednisona ou outro imunossupressor. Houve boa aceitação ao procedimento em 80,7% dos pacientes.

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Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

Mehndiratta

Hughes

Agarwal

2004

Cochrane Database of Systematic Reviews

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Evidence from two small trials showed that plasma exchange provides significant short-term benefit in about two-thirds of patients with chronic inflammatory demyelinating polyradiculoneuropathy but rapid deterioration may occur afterwards. Adverse events related to difficulty with venous access, use of citrate and haemodynamic changes are not uncommon. More research is needed to identify agents which will prolong the beneficial action of plasma exchange.

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Adverse reactions associated with mobile therapeutic apheresis:Analysis of 17,940 procedures

Cited by 48 publications

References 12 publications

Powikłania u chorych leczonych metodą plazmaferezy na oddziale intensywnej terapii

Powikłania u chorych leczonych metodą plazmaferezy na oddziale intensywnej terapii

Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients

Plasma exchange for chronic inflammatory demyelinating polyradiculoneuropathy

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