Therapeutic plasma exchange in neurological diseases: Eleven years experience at a tertiary care center in Turkey

Abstract

Therapeutic plasma exchange (TPE) is an apheresis procedure in which plasma is separated from the blood cellular components ex vivo, allocated, and replaced with another plasma or a plasma-replacing fluid. This study aimed to define the rate of complications and determine TPE distribution in various neurological diseases. Our study is a retrospective analysis of neurologic diseases requiring TPE between 2008 and 2019 that were selected using the medical records of neurology departments and apheresis units database. We performed 1459 TPE procedures on 207 patients between 2008 and 2019. TPE Procedure is most frequently applied in patients with Myasthenia-Gravis syndrome (34.7%). The complication ratio was 1.6% from a total of 1459 TPE procedures. The most commonly specified adverse event was allergic reactions 11 (5.3%), followed by hypotension 6 (2.9%). TPE was safe and tolerable, with manageable complications in experienced hands. K E Y W O R D Sacute inflammatory demyelinating polyradiculoneuropathy (AIDP), chronic inflammatory demyelinating polyneuropathy (CIDP), multiple sclerosis (MS), therapeutic plasma exchange

Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange

“…The principal finding of our study is that CVC use in TPE‐treated patients is associated with thrombotic complications. These thrombotic complications are likely driven by catheter‐related thrombosis, the most common thrombotic complication associated with TPE 43‐45 . In a single‐center analysis of 50 patients undergoing 699 TPE procedures, catheter‐related thrombosis occurred in four procedures (1.1%), which likely corresponds to four patients (8%) 16 .…”

“…Higher catheter‐related thrombosis rates occurred in a study of 378 TTP patients in which CVC was the primary risk factor in 35/48 patients (73%) who developed a thrombotic episode 43 . Nevertheless, the prevalence of catheter‐related thrombosis in TPE‐treated patients is variable with some studies reporting a low prevalence 45 . A study of 207 patients who underwent 1459 TPE procedures, all using CVCs (personal communication), reported only one thrombotic episode (<1%) 45 .…”

“…All bleeding episodes were related to vascular access and one episode required surgical intervention. In a report from the Canadian Apheresis Group that included 627 patients receiving 5235 TPE procedures for several indications, bleeding complications occurred in five procedures (<1%) 45 . One episode was related to CVC.…”

“…These thrombotic complications are likely driven by catheter-related thrombosis, the most common thrombotic complication associated with TPE. [43][44][45] In a single-center analysis of 50 patients undergoing 699 TPE procedures, catheter-related thrombosis occurred in four procedures (1.1%), which likely corresponds to four patients (8%). 16 Higher catheter-related thrombosis rates occurred in a study of 378 TTP patients in which CVC was the primary risk factor in 35/48 patients (73%) who developed a thrombotic episode.…”

“…43 Nevertheless, the prevalence of catheter-related thrombosis in TPE-treated patients is variable with some studies reporting a low prevalence. 45 A study of 207 patients who underwent 1459 TPE procedures, all using CVCs (personal communication), reported only one thrombotic episode (<1%). 45 Our study did not determine which thrombotic episodes were CVC-related and which were not.…”