Therapeutic plasma exchange: A study of indications and efficacy

Abstract

Background and Objectives: Therapeutic plasma exchange has been in use to treat a variety of diseases and for the purpose of rational decision-making, the American Society for Apheresis has proposed guidelines for the same. The present study was undertaken to study various aspects of the plasma exchange facility in a tertiary care center at Uttarakhand, India. Methods: The relevant demographical details (age, sex, BMI), clinical history of patient (any previous illness, any chromic disease, medications etc.), relevant investigations performed (basic haematology and immunology tests), plasma exchange procedure notes (total time taken, any adverse reactions noted), and replacement fluids used (type and amount used) were recorded and analyzed. Results: A total of 157 plasma exchange procedures were performed on 47 patients. Of these, maximum procedures were done for patients with Guillain–Barre syndrome (GBS), myasthenic crisis, and disseminated intravascular coagulation (DIC). The other indications were multiple myeloma, plasma cell dyscrasia, thrombotic thrombocytopenic purpura, and DIC after scrub typhus and dengue. The most common adverse reaction noted was urticaria (8/19), followed by perioral tingling (3/19) and hypotension (7/19). Interpretation and Conclusions: Fifteen out of 17 patients suffering from GBS and all patients of myasthenic crisis showed recovery, however, one patient of myasthenia gravis did not show immediate improvement, but recovered after some delay. Among the patients with thrombotic thrombocytopenic purpura with neurological manifestations, 3 out of 5 patients showed significant improvement. Patients who presented with other indications of plasma exchange also showed clinical benefits and the procedure resulted in quick recovery.