Therapeutic plasma exchange in a single center: Ibni Sina experience

Arslan, Önder; Arat, Mutlu; Tek, Ibrahim; Ayyildiz, Erol; İlhan, Osman

doi:10.1016/j.transci.2004.02.007

Cited by 18 publications

(25 citation statements)

References 4 publications

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“…TPE is used to treat diseases in many different medical specialties, but neurological disorders are currently the leading indications for TPE in our registry, as in other registries worldwide (4–16). The predominance of neurological indications started in 1987 with a sharp rise in the number until 1992.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, our database may be considered a “national registry,” since other national registries report coverage of 90–95% of TPE procedures (4–16). Our registry also covers the longest observation period in published literature to the best of our knowledge (4–16). The number of TPEs and patients who underwent this procedure increased several‐fold over 27 years of follow‐up despite changes in the pattern of indications and the emergence of new, more selective therapeutic options (LDL apheresis, immunoadsorption, etc.).…”

Section: Discussionmentioning

confidence: 99%

“…Neurological indications still constitute the largest group of indications for TPE, but their number is not increasing. The cause is probably the use of high doses of intravenous immunoglobulin in the treatment of Guillain‐Barré syndrome and myasthenia gravis, two leading neurological indications for TPE worldwide (4–16). Within the next few years, another medical specialty may take the leading position, probably hematology or nephrology (18).…”

Section: Discussionmentioning

confidence: 99%

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Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia

2011

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Results from recent trials and advances in the fields of medicine and technology have altered the spectrum of indications for use of therapeutic plasma exchange. In this article we analyze changes in indications for therapeutic plasma exchange that have occurred during 27 years in Croatia. We retrospectively analyzed the database of the Department of Dialysis at the University Hospital Center, Zagreb (678 patients; 6596 procedures), for changes in indications for therapeutic plasma exchange from 1982 to 2008. The number of patients and procedures increased several-fold during the follow-up period, but the mean number of procedures per patient per year did not change significantly. Neurological disorders constituted the largest group of indications for therapeutic plasma exchange (66% of all indications), followed by hematological (16%), nephrological (6%), and rheumatological disorders (6%). Myasthenia gravis was the most frequent indication during the entire follow-up period, but the pattern of other indications changed, with the most frequent at the beginning of follow-up becoming the least frequent at the end of follow-up. The five most frequent indications represented 62.2% of all indications at the beginning of follow-up, whereas during the 1990s, this percentage increased to more than 90% of all indications. Since the year 2000, the spectrum of indications has grown, and the percentage of the five most common indications decreased to 79.9%. Despite changes in indications for therapeutic plasma exchange, this procedure is still applicable in various medical fields, either traditional or newly created with the development of medicine and technology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia

2011

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“…Typical replacement fluids for TPE are human plasma, albumin, colloids, crystalloids, or combination of them (23–25). It is currently unknown if the kind of replacement influences the clinical outcome in septic patients treated with TPE.…”

Section: Discussionmentioning

confidence: 99%

“…Questions arise if the presence of plasma or absence of HES is responsible for the prolonged survival or a combination of both. HES is used for volume replacement therapy in anesthesia and intensive care medicine; it is also used as replacement fluid for plasma exchange (23–25) despite a lack of clinical superiority over crystalloids by meta‐analysis or large clinical trials (26,27).…”

Section: Discussionmentioning

confidence: 99%

Role of Different Replacement Fluids During Extracorporeal Treatment in a Pig Model of Sepsis

Sauer¹,

Altrichter

Mencke³

et al. 2012

Ther Apher Dial

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In an extracorporeal combination therapy, the impact of different replacement fluids on survival was tested in a bacterial sepsis model in pigs. In an animal study 19 pigs, weighing 7.5-11.1 kg, were included. All groups received an intravenous lethal dose of live Staphylococcus aureus over 1 h. The animals were treated by an extracorporeal circuit consisting of online centrifugation and subsequent plasma filtration for 4 h. The extracorporeal circuit was pre-filled with 400 mL replacement fluid. In the P0 group 100% hydroxyethyl starch 130/0.4 was used as replacement fluid; in the P30 group 30% pig plasma and 70% hydroxyethyl starch; and in the P100 group 100% pig plasma. The observation time was 7 days. All animals of the group P100 survived, while all animals of group P0 and five out of seven animals of the P30 group died during the observation time. Extracorporeal therapy consisting of online centrifugation and plasma filtration with 100% pig plasma as replacement fluid significantly improved survival in a pig model of sepsis. Further studies with this approach are encouraged.

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Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used

Kohli

Geneen

Brunskill

et al. 2022

J of Clinical Apheresis

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ObjectiveThe 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).MethodsWe searched electronic databases using a predefined search strategy from inception to October 9, 2020. Two reviewers independently screened and extracted data.ResultsWe 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.ConclusionFuture 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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Therapeutic plasma exchange in a single center: Ibni Sina experience

Cited by 18 publications

References 4 publications

Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia

Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia

Role of Different Replacement Fluids During Extracorporeal Treatment in a Pig Model of Sepsis

Assessing efficacy and safety of replacement fluids in therapeutic plasma exchange: A systematic scoping review of outcome measures used

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