Therapeutic Plasma Exchange - An Emerging Treatment Modality in Patients with Neurologic and Non-Neurologic Diseases.

Abstract

Therapeutic Plasma Exchange (TPE) is a procedure in which the patient's blood is passed through an apheresis machine, where the filtered plasma is removed and discarded with reinfusion of red blood cells along with replacement fluid such as plasma or albumin in to the patient. We present our experience with TPE in treatment of various neurologic and non-neurologic diseases. To evaluate TPE as primary therapy or as a first-line adjunct to other initial therapies as mentioned by American Society for Apheresis (ASFA). A retrospective analysis of TPE procedures was done for a period of nine years, from January 2007 to May 2016 in a tertiary care teaching hospital. A total of 584 TPE procedures were performed in 161 patients between 2 to 75 years of age. Clinical and laboratory investigations like ECG, chest X-ray, cardiorespiratory status and serology were carried out before the TPE procedure. A total of 161 patients were enrolled in the present study. Guillain-Barre Syndrome (GBS) (67.7%, n=109) was the main indication for TPE, followed by Myasthenia Gravis (MG) (13.04%, n=21). Overall incidence of adverse reactions was 9.93%, inadequate vascular access was a common complication encountered in paediatric age group. Our results show that TPE is not only safe and effective treatment alternative to Intravenous Immunoglobulin (IVIG), it also strongly holds evidence in the improvement of neurological disorders compared to non-neurological disorders. There is need of further detail evaluation on large number of cases for proper evidence based practice.