Therapeutic plasma exchange: Experience in a third level hospital, 2013-2016, Lima (Peru).

Abstract

Therapeutic plasma exchange (TPE) is an extracorporeal procedure which consists of removing the patient's plasma and replacing it with an appropriate replacement fluid. Plasma and blood cells are separated by a centrifugation process. Our department has used TPE for several years, and in 2013 we introduced an institutional apheresis protocol. The main objective of this report is to describe the TPE procedures performed between 2013 and 2016 in the Peruvian population. We analyzed the technical and clinical aspects of 864 centrifugal TPE procedures as well as the associated complications. We evaluated 230 patients treated in our institution. The therapeutic indications included 16 different diseases: 89.5% (N = 206/230) neurological, 7.3% (N = 17/230) hematological, 1.7% (N = 4/230) rheumatologic, 0.8% (N = 2/230) dermatological and 0.4% (N = 1/230) nephrological. 70.4% (N = 142/230) of patients were diagnosed with Guillain-Barré syndrome. Albumin 5% solution was the most frequent replacement solution, used in 65.8% (N = 569/864) of the procedures. The mean plasma volume (PV) replaced was 2451.73 ml, corresponding to 1.0 PV in all procedures. Complications occurred in 10.9% (N = 95/864) of the sessions. Allergic reactions were the most common events and cardiopulmonary arrests were recorded in two patients. This is the first report of TPE performed in the Peruvian population. The use of an institutional apheresis protocol was beneficial to improve registries in our service and our professional health attention. This study reports a low rate of complications, suggesting that TPE is safe. There is a need to create a multicenter Peruvian apheresis registry to assess the benefits and risks of TPE in Peru.