The Complications of Therapeutic Plasma Exchange

Abstract

We reviewed a series of 181 patients who were treated with therapeutic plasma exchange ( TPE ) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post- TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.

Platelet transfusions and bleeding complications associated with plasma exchange catheter placement in patients with presumed thrombotic thrombocytopenic purpura

“…In 1984, Ziselman et al [5] reported on the complications of therapeutic plasma exchange creating a classification of "serious" and "less serious" complications. Serious complications include death within hours of treatment, myocardial infarction, and pulmonary embolism.…”

A Retrospective study of complications of therapeutic plasma exchange in myasthenia

“…Overall, complications are estimated to occur in 5 to 49% of patients who undergo TPE,6, 16–22 and serious complications occur in less than 1% of exchanges 23. In neurologic disease, estimates of complications range from 15 to 28%, and serious complications have been reported in 5 to 22% of patients 7, 12, 15, 24, 25.…”

Complications of Apheresis

“… Data extracted from references (4–12) comprising over 15,000 treatments. Adapted from Mokrzycki, Kaplan: Am J Kidney Dis 23:817, 1994. …”

“…Rare cases of thrombosis have been associated with the prolonged use of indwelling vascular catheters (12). Pulmonary embolism, cerebral ischemia, and myocardial infarction have been reported to occur in association with apheresis, but the incidence is rare (0.06–0.14%) (6,36)…”

“…Several previous reports identified the potential complications of therapeutic apheresis (1)(2)(3). A few large series assess the incidence of these complications (4)(5)(6)(7)(8)(9)(10)(11)(12). A composite of adverse reactions involving over 15,000 treatments reveals that the most common are citrateinduced paresthesias, muscle cramps, and urticaria (Table 1) (12).…”