Impediments that Challenged Therapeutic Plasma Exchange: Experience at a Tertiary Care Hospital in Bangladesh
Asian Journal of Medicine and Health,
Page 124-134
DOI:
10.9734/ajmah/2022/v20i11751
Abstract
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that removes circulating antibodies, toxin and mediators from the plasma of the patients. This study was conducted to assess the safety, type and frequency of complications with regard to the indications and technical aspects of the TPE procedure performed in patients referred with different indications. A total of 127 patients’ clinical data treated with 424 TPE cycles over a period of 6 years from June 2016 to July 2022 at the apheresis unit of the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University in Bangladesh, were enrolled in this retrospective observational study. The median age was 35.26 years (range 19–63) with a male predominance. The indications were mostly American Society for Apheresis (ASFA) category I (81.895%) and the most common indications were neurological indications including Guillain–Barré Syndrome (GBS) (61.41%), Myasthenia Gravis (MG) (10.24%) followed by Acute Liver Failure (7.09%). Venous access was established with the femoral vein maintaining blood flow at 70 ml/min using acid citrate-dextrose solution A (ACD-A) anticoagulant. TPE was frontline therapy in 55.91% of the patients. Human albumin was used as a replacement fluid in 88% and fresh frozen plasma in 12% of the cycles. Incidence of procedural complication was 49% (n = 206) and majority of them were mild (n = 191; 45%) with only 3% and 0.47% being moderate and severe, respectively. Mild complications were hypocalcemia (n = 127; 29.95%), anxiety (n = 109; 25.70%), restlessness (n = 68; 16.04%) and hypotension (n = 46; 10.85%) in albumin group and anxiety (n = 31; 7.31%), hypocalcemia (n = 23; 5.42%), muscle cramp (n = 23; 5.42%) in FFP group. Interestingly, complications were almost similar in albumin and FFP groups except for allergic reactions and mild reactions which were mostly manageable and preventable with continuous, cautious monitoring. Our findings suggest that TPE is a relatively safe procedure and severe complications such as hypotension and anaphylaxis is preventable through continuous and dedicated monitoring by expert personnel.
Keywords:
- Therapeutic plasma exchange
- complication
- albumin
- FFP
- hypocalcemia
How to Cite
References
Schwab PJ, Fahey JL. Treatment of Waldenstrom’s macroglobulinemia by plasmapheresis. N Engl J Med. 1960; 263:574–9.
Wong EC, Balogun RA. Therapeutic apheresis in pediatrics: Technique adjustments, indications and nonindications, a plasma exchange focus. J. Clin. Apher. 2012;27:132–7.
Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH. Guidelines on the use of therapeutic apheresis in clinical practice—evidence‐based approach from the Apheresis Applications Committee of the American Society for Apheresis. Journal of Clinical Apheresis. 2010;25(3): 83-177.
Ara F, Hassan MS, Yusuf MA, Nasreen Z, Islam A, Alam MB, Mohammad QD. Complications of therapeutic plasma exchange in patient with neurological disorders. Journal of National Institute of Neurosciences Bangladesh. 2017; 3(2):69-74.
Islam SS, Ferdous J, Hoque A, Rahman A. Therapeutic Plasma Exchange in Guillain Barre Syndrome: An experience of Bangabanhu Sheikh Mujib Medical University, Bangladesh. European Journal of Medical and Health Sciences. 2022; 4(1):11-3.
Al Mukit A, Al Mahtab M, Rahim MA, Noor-E-Alam SM, Das DC, Moben AL, Khondaker FA, Alam MA, Begum R, Haque ME, Islam MA. Plasma Exchange in Patients of Acute on Chronic Liver Failure: An Observational Study in Bangladesh. Euroasian Journal of Hepato-Gastroenterology. 2022;12 (1):1.
Afroz T, Sultana S, Muquith T, Noor MM, Chowdhury MA, Haq QS, Saleh AJ. First Successful Therapeutic Plasma Exchange in A 3-Year-5-Month Old Bangladeshi Paediatric Patient: A Case Report. Haematology Journal of Bangladesh. 2020; 4(1):19-22.
Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Therapeutic apheresis and dialysis. 2005;9(5):391-5.
Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: complications and management. American Journal of Kidney Diseases. 1994;23(6):817- 27.
Goldstein SL. Therapeutic apheresis in children: special considerations. In Seminars in dialysis. Oxford, UK: Blackwell Publishing Ltd. 2012;25(2):165-170.
Borberg H. Problems of plasma exchange therapy. InTherapeutic plasma exchange 1981;191-202). Springer, Berlin, Heidelberg.
Sutton DM, Nair RC, Rock G. Complications of plasma exchange. Transfusion 1989; 29:124–7.
Rizvi MA, Vesely SK, George JN, Chandler L, Duvall D, Smith JW, Gilcher RO. Complications of plasma exchange in 71 consecutive patients treated for clinically suspected thrombotic thrombocytopenic purpura‐hemolytic‐uremic syndrome. Transfusion. 2000;40(8):896-901.
Lu J, Zhang L, Xia C, Tao Y. Complications of therapeutic plasma exchange: A retrospective study of 1201 procedures in 435 children. Medicine. 2019; 98(50).
Ziselman EM, Bongiovanni MB, Wurzel HA. The complications of therapeutic plasma exchange. Vox Sang 1984; 46:270–6.
Basic‐Jukic N, Kes P, Glavas‐Boras S, Brunetta B, Bubic‐Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Therapeutic apheresis and dialysis. 2005; 9(5):391-5.
Tombak A, Uçar MA, Akdeniz A, Yilmaz A, Kaleagası H, Sungur MA, Tiftik EN. Therapeutic plasma exchange in patients with neurologic disorders: review of 63 cases. Indian Journal of Hematology and Blood Transfusion. 2017; 33(1):97-105.
Song EY, Kwon SW, Kim DS, Kim DW, Kim DW, Kim HO, Park CW, Suh JS, Ryang DW, Lee JN, Lee JW. Current status of therapeutic plasma exchange in Korea. Therapeutic Apheresis and Dialysis. 2004;8(2):97-101.
Szczeklik W, Wawrzycka K, Włudarczyk A, et al. Complications in patients treated with plasmapheresis in the intensive care unit. Anaesthesiol Intensive Ther 2013; 45:7–13.
Laird JH, Douglas K, Green R. Heparin‐induced thrombocytopenia type II: A rare but significant complication of plasma exchange. Journal of clinical apheresis. 2006;21(2):129-31.
Mateen FJ, Gastineau D. Transfusion related acute lung injury (TRALI) after plasma exchange in myasthenic crisis. Neurocrit Care 2008;8:280–2.
Korach JM, Petitpas D, Poiron L, Vincent N, Berger PH, Chillet P. French Registry Study Group. 14 years of therapeutic plasma exchange in France. Transfusion and Apheresis Science. 2001;25(1):73-77.
Malchesky PS, Koo AP, Rybicki LA. Apheresis technologies and clinical applications: the 2000 International Apheresis Registry. Therapeutic Apheresis. 2001;5(3):193-206.
Stafford CT, Lobel SA, Fruge BC, Moffitt JE, Hoff RG, Fadel HE. Anaphylaxis to human serum albumin. Ann Allergy. 1988; 61:85–8.
Korach JM, Berger P, Giraud C, Le Perff-Desman C, Chillet P. Role of replacement fluids in the immediate complications of plasma exchange. French Registry Cooperative Group. Intensive Care Med. 1998;24:452–8.
Randomised Trial of Plasma Exchange, Intravenous Immunoglobulin, and Combined Treatments in Guillain-Barre´ Syndrome Plasma exchange/ sandoglobulin Guillain-Barre´syndrome trial group. Lancet. 1997;49:225–230.
Weiss PF, Klink AJ, Friedman DF, Feudtner C. Pediatric therapeutic plasma exchange indications and patterns of use in US children's hospitals. Journal of Clinical Apheresis. 2012; 27(6): 287-94.
-
Abstract View: 148 times
PDF Download: 60 times
