Therapeutic plasma exchange: Experience in a third level hospital, 2013–2016, Lima (Peru)

Palma-García, Luis; Velásquez-Rimachi, Victor; Pezo-Pezo, Armando M.; Roig, Joseph; Perez-Villegas, Julio

doi:10.1002/jca.21623

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…The observed overall complication rates at our TPE unit (9.4%) were comparable with the recently reported experience in most centres and of the World Apheresis Association (WAA) apheresis registry, ranging from 5% to 12% 10 13 14 19. We observed no complications related to procedures for central venous vascular access, performed under ultrasound-guided by in-house interventional radiologists.…”

Section: Discussionsupporting

confidence: 86%

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Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

Wong

Hiew

2020

BMJ Neurol Open

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IntroductionTherapeutic plasma exchange (TPE) for semi-critical neurological manifestations can be managed in non-acute setting instead of critical care unit. In 2014, we established a non-acute neurology TPE unit for semi-critical haemodynamically stable patients. In this study, we aimed to evaluate the technical and safety parameters from the first 3 years of service.Materials and methodsWe analysed prospectively collected TPE data for patients treated with centrifugation TPE at our non-acute neurology TPE unit in Kuala Lumpur Hospital between May 2015 and June 2018.ResultsA total of 245 TPE procedures were performed in 55 patients for nine neurological indications, predominantly the central nervous system (79%). Twenty four per cent (n=13) had category I and 73% (n=40) had category II indication (American Society for Apheresis (ASFA) 2019). Others (4%) were not in ASFA indications. Neuromyelitis optica spectrum disorders accounted for half (51%) of the total patients. Twenty-three (41.8%) patients experienced adverse events, with hypotensive episodes being the the most common (n=12/55, 21.8%). Five (9.1%) patients had catheter-related blood stream infection, correlating with higher exchange plasma volume (p=0.023). Symptomatic hypocalcaemia was less common (n=5/55, 9.1%) and allergic reaction to human albumin was rare (n=1/55, 1.8%). Four technical errors detected. Three involved centrifugation sets manufacturing defects and one involved error in centrifugation set installation. Seven (2.9%) procedures were terminated: 5 for adverse effects and 2 for technical errors.ConclusionPerforming TPE among semi-critical patients with neurology manifestations in basic non-acute set-up proved safe, with predictable complications. This set-up reduced the reliance on critical care services for TPE procedures.

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Section: Discussionsupporting

confidence: 86%

“…At initial set-up of our non-acute TPE unit, we performed TPE for various central and PNS disorders, similar to other recently published data from established centres 13–15. With time, we observed an increase in TPE applications for CNS disorders indications.…”

Section: Discussionsupporting

confidence: 55%

Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

Wong

Hiew

2020

BMJ Neurol Open

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“…The incidence rate of TPE-related AEs varied in different regions, ranging from 3.4 to 9.9% in the US 34,35 and from 10.9 to 60% in other countries outside the US. [36][37][38] The result from our study indicated that the incidence rate of TPE-related AEs in rheumatic treatment was 15.1%, and plasma-induced allergic reaction was the most frequent complication, which is in line with a previous report. 37 Other common AEs included palpitations, dizziness/fatigue, nausea, and hypotension, accounting for 16.4%, 13.6%, 6.4%, and 6.4% in all episodes, respectively.…”

Section: Discussionsupporting

confidence: 92%

Experience of therapeutic plasma exchange in rheumatic diseases: Albumin may be a suitable substitute for plasma

2021

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Objectives: In this study, we aimed to assess the value of therapeutic plasma exchange (TPE) in the treatment of rheumatic diseases and compare the safety of different replacement fluids used in TPE. Patients and methods: A total of 727 TPE procedures in 285 patients (57 males, 228 females; mean age: 39.7±15.4 years; range, 13 to 79 years) with rheumatic diseases between January 2011 and February 2019 were retrospectively analyzed. Data including demographic and clinical characteristics of the patients were recorded. Treatment response to TPE and adverse events were evaluated in all patients. Results: Indications for TPE included 13 different disorders, with the majority being systemic lupus erythematosus (up to 50%). The mean number of TPE sessions was 2.55±1.00 per patient and the mean exchange plasma volume was 2,270±256 mL per session. Combined plasma and albumin was the most frequently used replacement fluid (69.5%), followed by albumin and plasma in 20.5% and 10.0% of episodes, respectively. Up to 73.7% (210/285) patients achieved clinical improvement after TPE treatment. Adverse events occurred in 15.1% (110/727) of all the procedures, and allergic reaction (34.5%) was the most common event. The overall incidence rate of complication was similar among the three types of replacement fluids (p=0.214). Conclusion: Based on our study results, TPE is an invasive, but safe, useful and, sometimes, essential tool with an acceptable risk/benefit ratio for most rheumatic diseases. Albumin can be used as a feasible substitute for plasma in case of shortage of blood resources.

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“…Among our patients who received TPE, the majority started this within the first two weeks, with enough cycles. This treatment was as recommended by the Pan-American Health Organization, the American Apheresis Society (ASFA) and a previous report from the HNDM 10,20,30 . However, not all patients improved during hospitalization, given that the time taken to reach improvement may be longer than the hospital stay 29 .…”

Section: Discussionmentioning

confidence: 99%

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru

Velásquez-Rimachi

López-Saavedra

Rodriguez-López

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system. Severe motor deficit (SMD), respiratory impairment, cranial nerve involvement and autonomic dysfunction are associated with a poor prognosis. Objective: To investigate the association between the clinical-epidemiological characteristics and the discharge results among Peruvian patients with GBS. Methods: We carried out a retrospective observational study on patients with GBS who survived until discharge. We used the Brighton Collaboration’s criteria and considered Hughes Severity Scale (HSS) scores greater than two to be SMD. We defined the discharge results as an improvement if the HSS score decreased by at least one point from admission to hospital discharge and defined hospital stay as prolonged if > 14 days. Results: We analyzed 92 patients, among whom 70.7% were male. Quadriparesis (81.1%) and hyporeflexia (86.8%) were the most characteristic manifestations. We observed that more than half of the cases were in summer and winter. Gastrointestinal infections were associated with a higher proportion of prolonged stays. The proportion of improvement was lower among patients who had an SMD at hospital admission. We confirmed these results through fitting in multivariate models. Conclusions: The prolonged stay was related to previous gastrointestinal infection, while a less improvement in SMD individuals at admission. Prospective multicenter surveillance systems are needed for monitoring GBS cases in low-income settings like Peru.

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Therapeutic plasma exchange: Experience in a third level hospital, 2013–2016, Lima (Peru)

Cited by 4 publications

References 20 publications

Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

Experience of therapeutic plasma exchange in rheumatic diseases: Albumin may be a suitable substitute for plasma

Clinical-epidemiological characteristics associated with discharge outcomes and seasonality among surviving patients with Guillain-Barré syndrome in a national third-level hospital, Lima, Peru

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