Complications Of Plasma Exchange Research Articles

The role of plasma exchange in hyperbilirubinemia from a different perspective

Objective: In this retrospective study, we aimed to present our experience of managing hyperbilirubinemia. Method: Twenty three patients with hyperbilirubinemia who received apharesis treatment between 2006 and 2017 at the apheresis unit of Cumhuriyet University School of Medicine were included in the study. Records of the patients were evaluated retrospectively and the following data were collected: patient’s age, sex, presenting symptoms, number of plasma exchange, adjuvant treatment modalities, use of replacement fluid, treatment outcomes, and plasma exchange complications . Results: The median age of the patients was 57 years (range; 18-82). The median number of plasma exchange was 5,5 (range; 1-25). Fresh frozen plasma was the only replacement fluid used. There was significant statistical differences between pre- and post-plasma exchange bilirubine levels (p<0.05). Toxic hepatitis was the most common cause of hyperbilirubinemia in our patient population. In addition to plasma exchange, patients were treated with proper treatment of the underlying condition. We observed allergic reactions 2 (8.69%) patients and hypotension in 3 (13%) patients as complications Conclusions: Plasma exchange is a safe method for the elimination of bilirubin. However, diminishing hyperbilirubinemia with plasma exchange together with the proper treatment of the underlying condition should be the primary goal in management.

Échanges plasmatiques en néphrologie : techniques et indications

Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Compensation by viro-attenuated plasma is reserved solely for the treatment of thrombotic microangiopathies or when there is a risk of bleeding, because this product is very allergenic and expensive. The treatment goal for a plasma exchange session should be between one and one and one-half times the patient's plasma volume estimated at 40 mL/kg body weight. The anticoagulation is best ensured by the citrate. Complications of plasma exchange are quite rare according to the French hemapheresis registry. The level of evidence of efficacy of plasma exchange in nephrology varies from one pathology to another. Main indications of plasma exchange in nephrology are Goodpasture syndrome, antineutrophil cytoplasmic antibody vasculitis when plasma creatinine is greater than 500 μmol/L, and thrombotic microangiopathies. During renal transplantation, plasma exchange may be proposed in the context of human leukocyte antigen (HLA) desensitization protocols or ABO-incompatible graft. After renal transplantation, plasma exchange is indicated as part of the treatment of acute humoral rejection or recurrent focal segmental glomerulosclerosis on the graft. Plasma exchanges are also proposed in the management of cryoglobulinemia or polyarteritis nodosa. Hemodialysis with membranes of very high permeability tends to replace plasma exchange for myeloma nephropathy. The benefit from plasma exchange has not been formally demonstrated for the treatment of severe lupus or antiphospholipid antibody syndrome. There is no indication of plasma exchange in the treatment of scleroderma or nephrogenic systemic fibrosis. More selective apheresis techniques such as immunoadsorption are currently proposed to replace plasma exchange.

The effect of evidence-based nursing on allergic reaction of the therapeutic plasma exchange patients

Objective To explore the application effect of evidence-based nursing in patients with therapeutic plasma.Methods Totaled of 70 patients with therapeutic plasma exchange in our hospital were divided into the observation group and the control group with the different nursing methods,the control group was given routine nursing,the observation group was given evidence-based nursing,the nursing effects were compared between the two groups.Results Acute complications of allergic reaction,sodium citrate,coagulation reaction in the observation group were significantly lower than those in the control group (P ＜ 0.05).Life quality score in associated symptoms and signs,the protection of vascular access,the ability of daily life and other aspects in the observation group was significantly higher than that in the control group (P ＜ 0.05).Nursing satisfaction in the observation group was higher than that in the control group (P ＜ 0.05).Conclusions Evidence-based nursing makes nursing more targeted; it can significantly reduce the plasma exchange complications,improve patient life quality. Key words: Evidence-based nursing ; Plasma exchange ; Allergic reaction ; Life quality ;

A31 A Review of the Complications of Plasma Exchange (PE) for Neurological Disease

A31 A Review of the Complications of Plasma Exchange (PE) for Neurological Disease

Complications of plasma exchange in patients treated for thrombotic thrombocytopenic purpura. IV. An additional study of 43 consecutive patients, 2005 to 2008

Complications of plasma exchange in patients treated for thrombotic thrombocytopenic purpura. IV. An additional study of 43 consecutive patients, 2005 to 2008

Randomized clinical trials in thrombotic thrombocytopenic purpura: where do we go from here?

Randomized clinical trials in thrombotic thrombocytopenic purpura: where do we go from here?

Complications of plasma exchange in patients treated for clinically suspected thrombotic thrombocytopenic purpura‐hemolytic uremic syndrome

BACKGROUND: With the increased frequency of diagnosis and improved survival of thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome (TTP-HUS), the morbidity of plasma exchange (PE) treatment has become more important. STUDY DESIGN AND METHODS: Data were prospectively collected on 71 consecutive patients referred to the Oklahoma Blood Institute (OBI) for PE treatment for clinically suspected TTP-HUS from mid-1996 to mid-1999. Complications were defined as major or minor, and distinguished between those related to central venous catheter access or to the plasma. RESULTS: Twenty-one patients (30%) had 27 major complications, which caused two deaths. The major complications included 2 episodes of hemorrhage after subclavian line insertion (1 death), 1 pneumothorax requiring a chest tube, 12 systemic infections (1 death), 7 episodes of catheter thrombosis requiring removal of the central venous catheter, 2 episodes of venous thrombosis requiring anticoagulant treatment, 2 episodes of hypoxemia and hypotension, and 1 episode of serum sickness. Minor complications occurred in 22 additional patients (31%). Twenty-eight patients (39%) had no complications. CONCLUSIONS: The morbidity and mortality of catheter placement and PE are important considerations when PE treatment for clinically suspected TTP-HUS is anticipated.

Síndrome de Guillain-Barré

To review about this disorder, with emphasis on the intensive care of severe Guillain Barr syndrome (GBS).GBS is an acute immune mediated inflammatory polyneuropathy that may lead to quadriparesis, ventilatory failure, and autonomic dysfunction but also to many general medical problems that have great bearing on outcome. Therefore severe GBS patients require admission into an intensive care unit (ICU), where in addition to the disorders mentioned before, other complications can arise. The neurologist who plans to deal comprehensively with these patients must be familiar with therapy for infections, nutrition, fluid management, and selected aspects of pulmonary medicine as well as the indications for and complications of plasma exchange and gammaglobulin infusion.With modern intensive care support, the outcome is excellent (>80% recovery), although in many cases a persistent residual paresis occurs. Because GBS is largely self limited, the skill daily cares of these patients in an ICU contributes as much, or more, to the overall outcome of an individual patient as do specific immune therapies.

Complications of plasma exchange in 71 consecutive patients treated for clinically suspected thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome.

With the increased frequency of diagnosis and improved survival of thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome (TTP-HUS), the morbidity of plasma exchange (PE) treatment has become more important. Data were prospectively collected on 71 consecutive patients referred to the Oklahoma Blood Institute (OBI) for PE treatment for clinically suspected TTP-HUS from mid-1996 to mid-1999. Complications were defined as major or minor, and distinguished between those related to central venous catheter access or to the plasma. Twenty-one patients (30%) had 27 major complications, which caused two deaths. The major complications included 2 episodes of hemorrhage after subclavian line insertion (1 death), 1 pneumothorax requiring a chest tube, 12 systemic infections (1 death), 7 episodes of catheter thrombosis requiring removal of the central venous catheter, 2 episodes of venous thrombosis requiring anticoagulant treatment, 2 episodes of hypoxemia and hypotension, and 1 episode of serum sickness. Minor complications occurred in 22 additional patients (31%). Twenty-eight patients (39%) had no complications. The morbidity and mortality of catheter placement and PE are important considerations when PE treatment for clinically suspected TTP-HUS is anticipated.

Complications of therapeutic plasma exchange: a recent assessment.

The use of therapeutic plasma exchange, particularly for management of patients with neurological disorders, has steadily increased in our hospital since 1991, thus highlighting the need for continuing quality assurance of these services. We have reviewed the hemapheresis records of all 381 therapeutic plasma exchange procedures performed on a total of 63 patients from January 1991 through December 1992. Patients were referred for therapeutic plasma exchange for the following indications: acute Guillain-Barre syndrome, 31 patients (49.2%); chronic inflammatory demyelinating polyneuropathy, 15 patients (23.8%); myasthenia gravis, five patients (7.94%); paraproteinemic neuropathy, five patients (7.94%); thrombotic microangiopathies, six patients (9.52%) and Goodpasture syndrome, one patient (1.6%). Overall, 89% of patients were treated for neurological disorders. Complications of plasma exchange were noted during 17% (n = 65) of procedures involving 49% (n = 31) of patients treated. Approximately 91% of complications were classified as mild (55.4%) or moderately severe (35.4%) and did not prevent successful completion of the procedure. These were largely related to use of citrate-containing anticoagulants and additionally may have reflected the autonomic instability of many of the neuropathy patients. All four (6.15%) severe complications and one of two fatalities were related to the use of central venous access catheters. We conclude that therapeutic plasma exchange can be performed safely with acceptable toxicity caused by mild and moderately severe complications. Major complications may be minimized by careful management of central venous catheters when required for access.

Complications of Plasma-exchange

Complications in apheresis affect on the average 40% of treated patients and 10-14% of the procedures. The mortality rate is 1/500 treated patients. The utilization of more complex techniques, central catheters, plasma infusion and even more the superimposition of different factors increase the incidence and gravity of side effects. Very influent are also the underlying pathologies and the clinical conditions; particularly at risk are patients with TTP/HUS and GBS. However, PE represents a relatively safe therapy in which prevention of complications requires a particularly diligent personnel and a careful evaluation of indications.

Complications of plasma exchange in patients with neurological diseases

SummaryPlasma exchange has proven to be effective in diseases of established or presumed autoimmune etiology as well as in hyperviscosity syndromes and some rare metabolic disorders. Its application is thought to be relatively safe; nevertheless, severe complications may occur. We therefore analyzed the complications of 291 exchanges in 39 patients with neurological diseases. Minor complications developed in 4.8% and major complications in 2.7% of procedures, including one death. Severe infections and technical problems have been the most serious side effects, sometimes followed by organ failure or even death.

Technical aspects and complications of plasma-exchange.

Technical aspects including technology for plasma-exchange, anticoagulation, blood access and blood substitutes are reviewed. The consequences of exchange on the level of various proteins are analyzed considering especially their role in coagulation disorders and immunomodulation. The complications which have been published and those which have been the result of a French inquiry are extensively analyzed. The mortality in this later experience is around 1% represented by non-cardiac pulmonary edema and cardiac circulatory failure. The factors which can reduce hazards are reviewed.

Complications of plasma exchange in neurological patients.

Complications occurred during 154 plasma exchanges performed in 17 patients for a variety of neurological disorders. Mild, self-limited, toxic reaction to citrate was the most frequent complication (7.8%), followed by transient hypotension (2.6%) and visual scotomata (1.3%). More serious complications, occurring on one occasion each, were cardiac arrhythmia, myocardial infarction, and gross hemolysis. There were no infections. The spectrum and frequency of complications in these plasma exchanges were compared with those in other series dealing with both neurological and nonneurological patients. Several risk factors for development of complications were identified, one of the most important being the nature of the illness being treated. The incidence of two of the most serious complications, severe infection and bleeding diathesis, appeared to be higher in patients with renal insufficiency or hematologic disorders, respectively, than in neurological patients.