Safety Of Plasma Exchange Research Articles

Efficacy and safety of plasma exchange for Kawasaki disease with coronary artery dilatation

BackgroundThe treatment of Kawasaki disease is controversial when intravenous immunoglobulin therapy fails, although it typically relies on combinations of prednisolone, infliximab, cyclosporine, and plasma exchange therapy. The goal of the treatment is no longer merely to reduce mortality but also to decrease the sequelae of coronary artery lesions, which are the most common and potentially life-threatening complications. Recently, plasma exchange therapy has been used to treat intravenous immunoglobulin-unresponsive Kawasaki disease with coronary artery lesions. When performed before coronary artery dilatation, the outcomes for plasma exchange are known to be excellent; however, when dilatation is already present, sequelae persist.MethodsBetween December 2006 and April 2015, we treated ten patients with Kawasaki disease complicated by coronary artery lesions that received plasma exchange because intravenous immunoglobulin therapy had proven to be ineffective. Here, we retrospectively review the efficacy and safety of plasma exchange therapy in such unresponsive cases against coronary artery lesions in patients with Kawasaki disease when plasma exchange performed after coronary artery dilatation.ResultsIn nine of the ten patients (90.0%), the body temperature was confirmed to be < 37.5 °C at an average of 2.7 ± 1.4 days after starting plasma exchange. Serum C-reactive protein levels decreased significantly from 9.9 ± 4.9 mg/dL before exchange to 1.9 ± 2.9 mg/dL after exchange (P < 0.05). One year after plasma exchange treatment, the coronary artery lesions had regressed to within normal limits in six of the ten patients. Although lesions remained in three patients, all three of these patients were asymptomatic. In addition, there were no stenosis of the coronary artery in nine of the ten patients. One patient died due to a ruptured giant coronary aneurysm 1 day after starting plasma exchange.ConclusionsIn conclusion, plasma exchange may be effective in not only regressing coronary artery lesions but also preventing sequelae in patients with Kawasaki disease when plasma exchange is performed after coronary artery dilatation.

Guillain–Barre syndrome in a 7-month-old boy successfully applied plasma exchange

Despite being the most common cause of acute flaccid paralysis in children Guillain–Barré syndrome has a low incidence under 18 years old, and is even rarer under the age of 2. Established treatment regimens include intravenous immunoglobulin and plasma exchange in older children and adults. However very limited data are available for the efficacy and safety of plasma exchange in infants younger than 12 month-old. This article presents the experience of plasma exchange in the case of 7-month-old boy diagnosed with Guillain–Barré syndrome.A 7-month-old boy was referred to the pediatric intensive care unit with a 10-day history of progressive weakness, feeding difficulty and constipation. He was diagnosed with axonal Guillain–Barré syndrome on the basis of clinical and electromyographical findings. The patient recovered fully with intravenous immunoglobulin and plasma exchange.Plasma exchange may be a safe option in the treatment in infants with Guillain–Barré syndrome as young as 7-month-age.

The efficacy and safety of plasma exchange in patients with sepsis and septic shock: a systematic review and meta-analysis.

IntroductionSepsis and septic shock are leading causes of intensive care unit (ICU) mortality. They are characterized by excessive inflammation, upregulation of procoagulant proteins and depletion of natural anticoagulants. Plasma exchange has the potential to improve survival in sepsis by removing inflammatory cytokines and restoring deficient plasma proteins. The objective of this study is to evaluate the efficacy and safety of plasma exchange in patients with sepsis.MethodsWe searched MEDLINE, EMBASE, CENTRAL, Scopus, reference lists of relevant articles, and grey literature for relevant citations. We included randomized controlled trials comparing plasma exchange or plasma filtration with usual care in critically ill patients with sepsis or septic shock. Two reviewers independently identified trials, extracted trial-level data and performed risk of bias assessments using the Cochrane Risk of Bias tool. The primary outcome was all-cause mortality reported at longest follow-up. Meta-analysis was performed using a random-effects model.ResultsOf 1,957 records identified, we included four unique trials enrolling a total of 194 patients (one enrolling adults only, two enrolling children only, one enrolling adults and children). The mean age of adult patients ranged from 38 to 53 years (n = 128) and the mean age of children ranged from 0.9 to 18 years (n = 66). All trials were at unclear to high risk of bias. The use of plasma exchange was not associated with a significant reduction in all-cause mortality (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.45 to 1.52, I2 60%). In adults, plasma exchange was associated with reduced mortality (RR 0.63, 95% CI 0.42 to 0.96; I2 0%), but was not in children (RR 0.96, 95% CI 0.28 to 3.38; I2 60%). None of the trials reported ICU or hospital lengths of stay. Only one trial reported adverse events associated with plasma exchange including six episodes of hypotension and one allergic reaction to fresh frozen plasma.ConclusionsInsufficient evidence exists to recommend plasma exchange as an adjunctive therapy for patients with sepsis or septic shock. Rigorous randomized controlled trials evaluating clinically relevant patient-centered outcomes are required to evaluate the impact of plasma exchange in this condition.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0699-2) contains supplementary material, which is available to authorized users.

Efficacy and safety of plasma exchange: an 11-year single-center experience of 2730 procedures in 317 patients

We reviewed retrospectively 317 patients who received 2730 plasma exchange (PE) procedures. According to guidelines published by the American Society for Apheresis (ASFA) in 2013, there were 220 (69%), 55 (17%), 32 (9%), and 7 (4%) patients who were treated with PE for a disease or condition considered as category I, II, III, and IV, respectively. Overall, 73%, 72%, and 69% of the patients showed an improvement of the underlying disease or condition at the end of the PE, and at 3 months and at 6 months after finishing the PE, respectively. We observed adverse effects in 90 (3%) PEs.

Efficacy and safety of plasma exchange: a 10-year singlecenter experience of 2,730 procedures in 317 patients

Efficacy and safety of plasma exchange: a 10-year singlecenter experience of 2,730 procedures in 317 patients

Plasma Exchange in Secondary Progressive Multiple Sclerosis: Twenty-Five Year Follow-Up Study

Secondary Progressive multiple sclerosis (SPMS) is a common form of MS with few approved and effective therapies. Previous studies of therapeutic plasma exchange (PLEX) in SPMS have reported mixed results. The purpose of this study was to evaluate long-term efficacy and safety of PLEX in SPMS. We retrospectively analyzed 25 years of PLEX therapy in SPMS to identify improvements in disease progression and disability as well as potential predictors of therapeutic success. Using 271 patients, we show a significant improvement in Expanded Disability Status Scale (EDSS) lasting for at least three years following a course of PLEX. Furthermore, disability remained significantly improved or stabilized for seven years post-PLEX. Patients with continued and measureable disability worsening in the previous three years are more apt to improve with PLEX. A small number of patients (N=42) for whom PLEX was considered but denied by their insurance carriers, and who therefore received other treatments, were also followed over the 25 year period. Progression of disability in this group was significantly worse when compared with PLEX group. No major problems occurred during 8709 PLEX procedures. Peripheral vascular access (venous or arterial) was utilized to avoid complications related to central line placement. Because of the paucity of beneficial therapeutic interventions in SPMS and the relative safety and efficacy of long-term PLEX, this therapy should be considered in this form of MS.

Safety of plasma exchange therapy in patients with myasthenia gravis

Plasma exchange (PLEX) is effective in myasthenia gravis (MG), but there are concerns about its safety. We collected data prospectively from 42 patients randomized to PLEX treatment in a comparison study with intravenous immunoglobulin (IVIg). Detailed information on the PLEX treatment methodology and adverse events are reported. Forty of 42 patients completed PLEX. Ninety percent were treated in an outpatient setting. Fifty-five percent had no complications, and 45% had mild-moderate reactions that did not require stopping treatment; the majority were citrate reactions and peripheral vascular issues that were easily treated. Fifty-seven percent of patients responded to treatment, and 83% completed PLEX via peripheral venous access. Two patients had severe adverse events: 1 related and 1 unrelated to PLEX. Comorbid disease and age did not predict reactions. PLEX is safe, effective, and well tolerated in patients with MG. Our results do not raise concerns about the safety of PLEX in patients with moderate-severe MG.

Trend of indications for therapeutic plasma exchange at an Iranian university hospital

Background: There is neither a registry system nor center-by-center reports on therapeutic plasma exchange in Iran. We evaluated the trend of indications as well as techniques and safety of plasma exchange in a single center in Iran. Methods: All registered cases in the plasma exchange unit of Al-Zahra hospital between 1996 and 2005 accounting for 560 patients (260 men, 300 women; median age 29, range 1–95 years) who underwent a total of 3985 procedures were included. Data collection was performed using the official questionnaire of the International Apheresis Registry System. Results: The total number of procedures per year has remained stable corresponding to a median of 9 treatments per 100,000 inhabitants. Of the 560 patients, the majority had neurologic (62.8%), followed by hematologic disorders (16.9%). The three most common indications were: Guillain–Barré syndrome (27.8%), myasthenia gravis (23.0%) and thrombotic thrombocytopenic purpura (11.4%). Three hundred and seventy-nine patients (67.7%) belonged to category I of the ASFA indication classification, 28 (5%) to category II, 104 (18.5%) to category III, and five (0.9%) to category IV. Forty-four cases (7.8%) were unclassified. All plasma exchanges were performed with a discontinuous flow centrifugation method. Normal saline + albumin (5%) was the main liquid of replacement (77.9%). Conclusion: The trend of indications in our center is comparable to international data. However, the average number of procedures in our population is lower than world statistics and the method of plasma exchange has not been modified.

Role of plasma exchange in the treatment of primary vasculitides

Plasma exchange (PLEX) has been part of the therapeutic armamentarium for vasculitis for over 40 years and this article reviews the indications, strength of evidence and safety of PLEX in the vasculitides. The relative rarity of these autoimmune diseases and incomplete understanding of their pathogenesis coupled with a lack of the development of a robust scientific rationale for PLEX therapy has hampered the conduct of large controlled trials. The use of PLEX has changed in recent years to reflect the improved evidence from controlled trials and PLEX is currently recommended for primary vasculitides such as ANCA-associated vasculitis with severe renal failure and cryoglobulinemia, whilst there is less evidence to guide its use in Henoch–Schonlein purpura and polyarteritis nodosa (PAN). PLEX remains a nonselective, costly therapy with common adverse events and uncertainty remains over the optimal method of application, frequency, dose, replacement solution, monitoring and integration of PLEX with other the...

Plasma Exchange During Cardiopulmonary Bypass in Patients With Severe Hemolysis in Cardiac Surgery

Severe mechanical hemolysis after cardiac surgery is a rare occurrence but one of the most common complications leading to reoperation. The aim of this study was to assess the efficiency and safety of plasma exchange (PE) during cardiopulmonary bypass (CPB). Five patients required PE because of severe hemolysis after cardiac surgery in Fuwai Hospital from January 2002 to December 2007: two with periprosthetic leakage and infective endocarditis, one with periprosthetic leakage, one with unsatisfied right ventricular outflow tract patching, and one with thromboses during extracorporeal membrane oxygenation (ECMO). They all needed blood purification to avoid acute renal insufficiency. The amount of transfused crystalloid solution, nonprotein colloid, plasma, and blood were 1,620+/-906.6 mL, 1,960+/-939.7 mL, 2,240+/-844.4 mL, and 680+/-228.1 mL. The volume of PE was 3,800+/-1,701.5 mL, and the volume of ultrafiltrate was 2,470+/-1,327.4 mL. The concentration of free hemoglobin (FHb) before PE, after PE, and before discharge were 3,840+/-538 mg/L, 325+/-27 mg/L, and 60.4+/-27 mg/L, respectively. Five patients were successfully treated with PE during CPB without major complications. All patients recovered well. Plasma exchange during CPB for severe hemolysis is a safe technique. Acute renal failure induced by severe hemolysis can be prevented by PE.

Plasma exchange for refractory Kawasaki disease.

Plasma exchange was a safe, effective prophylactic measure against coronary artery lesions in children with Kawasaki disease refractory to intravenous gamma globulin therapy. Kawasaki disease (KD) is an acute, systemic vasculitis of unknown aetiology that occurs predominantly in infants and young children [2]. Studies have indicated that immune system activation elevates interleukin-1b, interferon-c and tumour necrosis factor levels [3, 4], possibly activating endothelial cells and damaging the intima. Annually, KD causes coronary artery lesions (CALs) in some 500 Japanese children, but intravenous gamma globulin (IVGG) decreases their incidence from 25% to 8% of all KD cases. We examined the efficacy and safety of plasma exchange (PE) against CALs in children with KD refractory to IVGG therapy. KD was diagnosed according to the 1984 revised criteria. Children received IVGG (400 mg/kg per day for 3 days or 1 g/kg in a single infusion) and acetylsalicylic acid (30 mg/kg per day), and non-responders received PE, all within 10 days. CALs [1] were of three types (transient dilatation (TD), which regressed to the normal range within 30 days; persistent CAL (PD) and giant aneurysms (GA), without regression at day 30, but with respective lumen diameters 38.0oC) 48 to 72 h after IVGG were intractable to the initial IVGG [5, 6]. PE was performed, after informed parental consent was received, in those 27 children not responding to the further IVGG therapy (1 g/kg) administered to 75 children. Outcomes in the 27 were compared with those in the other 48 who received a third course of IVGG. No demographic or gender differences were demonstrated between children with (group A) and without (group B) PE therapy. Although group A patients received more IVGG (P=0.0515), they were still judged refractory to IVGG. In group A, 24 had no CALs, as demonstrated by serial echocardiography. Unfortunately, three children (11.1%) developed CALs. In group B, the inflammatory changes in 25 children resolved without coronary complications after the second IVGG; however, 23 children (47.9%) developed CALs. Furthermore, the rate of development of clinically severe CALs (PD plus GA) was 2 in 27 patients (7.4%) in group A, and 10 in 48 patients (20.8%) in group B (P =0.012). Multivariate analysis demonstrated that the most advantageous characteristic was PE therapy (odds ratio 0.041, P=0.0004) (Table 1). T. Imagawa and M. Mori contributed equally to this paper.

Effect of Plasma Exchange in Kawasaki Disease Refractory to High Dose Intravenous Gammaglobulin Therapy

Background: In Kawasaki disease (KD), administration of intravenous gammma-globulin (IVGG) reduced frequency of coronary artery lesion (CAL) from 25% to 8%. However, approximately 500 children still develop CAL every year in Japan. We evaluated the efficacy and safety of plasma exchange (PE) for children with KD intractable to IVGG therapy. Patients and Methods: Among 255 children with KD treated with initial IVGG, 119 children were identified at high risk for CAL according to the increases in fractional changes (FC) of white blood cell count, neutrophils, and CRP between baseline and 1 to 2 days after IVGG treatment. Seventy-five were administered additional IVGG, and finally 50 of them were underwent the PE therapy in 3 consecutive days. All the children were serially monitored for the development of CAL by echocardiography during the course of the disease until days 28-30. The incidence of CAL was compared among the children treated and those untreated with PE. Results: The demographic differences between the treated and untreated children were not significant on admission. The PE therapy was safely performed without any adverse reactions, and has completed in each child. Out of 50 children treated PE, only 10 (20.0%) had CAL, including temporary dilatation in 7, persistent CAL in 1, and giant aneurysms in 2 children. In contrast, 24 children (40.7%) among 69 without PE were affected with CAL, including giant aneurysm in 5 (P < 0.0004). Conclusions: We suggested that PE therapy performed within 10 days after the onset of the disease should be effective and safe for the children with KD intractable to the IVGG therapy. The PE therapy may be applied as soon as possible when the fractional increases in inflammatory markers after the initial IVGG are determined.