PREMEDICATION REGIMEN FOR THE PREVENTION OF ADVERSE REACTIONS ASSOCIATED WITH THERAPEUTIC PLASMA EXCHANGE

Abstract

<h3>Introduction</h3> Therapeutic plasma exchange (TPE) is an essential treatment for various conditions as it removes plasma containing self-reactive antibodies and proteins, replacing them with isosmotic fluid. Among the commonly encountered complications, hypersensitivity reactions, including urticaria, pruritus and anaphylaxis have been reported to occur in 3-12% of patients. Information regarding effective prophylactic management to prevent these reactions is lacking. We present a case where hypersensitivity reactions to TPE were prevented using an iodinated contrast premedication protocol. <h3>Case Description</h3> A 25-year-old male patient with a history of ESRD status post deceased donor transplant with mixed rejection was evaluated for an adverse reaction during TPE. He had previously received nine treatments, six months prior which were well-tolerated. During the first of eight TPEs, the patient developed urticaria, eyelid edema and dyspnea. Given the reaction, he was pre-medicated for subsequent TPEs with methylprednisolone 40mg IV, 5 hours and 1 hour prior to TPE and diphenhydramine 50mg IV 1 hour prior to TPE. Future TPEs were well-tolerated with the premedication regimen with the exception of mild hives during his sixth session. <h3>Discussion</h3> Although TPE hypersensitivity reactions have been commonly reported, an effective method of premedication has yet to be established. We aim to bring awareness of a premedication regimen prior to TPE using a 5 hour and 1 hour IV protocol in patients with hypersensitivity reactions related to the procedure.