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.

Mechanisms of adverse effects during hemapheresis

“…Findings of the Canadian Apheresis Study Group are similar to those of Puig et al, [3] who reported mild adverse effects during 18% of plasma exchanges, but differ from those of Ziselman et al, [4] who noted complications with only 1.6% of plasma exchanges and 11% of patients. Variable reporting of complications likely is related to the mild and transient nature of most reactions (i.e., they are discounted).…”

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

“…Adverse reactions related to vascular access were more frequent in this study than in previous reports [3,5,6,8,11]. This may be due to the higher frequency of central venous access use that was required for patients treated in intensive care units.…”

“…Calcium gluconate was used in this study in an attempt to decrease the occurrence of ACD related reactions. Unfortunately, it is impossible to make comparisons with previous studies [3,5,6,8,[10][11][12][13] because adverse reactions are often reported differently and the use of intravenous calcium is not always mentioned. In our study, patients with myasthenia gravis appeared to be more sensitive to ACD than patients with other diseases.…”

Complications of plasma exchange in patients with neurological diseases

“…Most of the complications were of minor significance, but there were also 28 severe episodes (0.5% of exchanges), ranging from marked allergic reactions to cardiac and respiratory arrest. Ziselman et al [16] reported 6 severe complications (e.g., myocardial infarction, pulmonary embolism, cerebral ischemia, hypoxia) within 1389 exchange procedures. In their study there were 6 additional events which were due to technical sources (loss of venous access, clotting within the access lines, tubing leaks, and hemolysis).…”