Therapeutic plasma exchange in a single center: Ibni Sina experience

Abstract

Background: The number of therapeutic procedures is increasing steadily year by year with growing collaboration of departments other than Hematology. In the aim to demonstrate our single center activity we analyzed our data since four years. Methods: Between years 1998 and 2001, 658 therapeutic plasma exchange (TPE) procedures were performed on 158 patients. Median age and male/female ratio were 37 (range, 15–87) and 80/78, respectively. Main indications were myastenia gravis ( n=55, 34%), TTP ( n=13, 8.5%), post ABO mismatched allogeneic hematopoietic cell transplantation aregeneratoric anemia ( n=6, 7.5%), progressive systemic sclerosis ( n=10, 6.5%), multiple myeloma ( n=10, 6.5%), Gullian Barre Syndrome ( n=9, 5.9%), multiple sclerosis ( n=7, 4.6%), Waldenström Macroglobulinemia ( n=5, 3.4%), polymyositis ( n=4, 2.7%), sepsis and disseminated intravascular coagulation ( n=4, 2.7%). Departments who referred the majority of the patients for TPE were neurology ( n=199), hematology ( n=153), immunology ( n=78), intensive care unit ( n=78) and thorax surgery ( n=51). Results: The median TPE procedure per patient was 4 (range, 1–50). All the procedures were performed on continuous flow cell separators and median plasma volume processed per cycle was 2471 ml (range 436–5000). The replacement fluids used were 3% hydroxyethylstarch (HES) (24%), 5% albumin (35%), fresh frozen plasma (25%), and HES and albumin (16%). HES was tolerated well even as a sole replacement fluid with acceptable minor side effects. In three patients with progressing hypoalbuminemia HES was replaced or combined with 5% albumin. Close monitoring of serum albumin and fibrinogen levels after repeated procedures is mandatory. Conclusion: In our four years of TPE experience we have increased our collaboration with other departments. 3% HES ± 5% Albumin is a feasible, well tolerated and cost effective replacement fluid combination especially for short-term plasma exchange therapy.