Citation Information :
Ahammed Nizar OT, Rai P, Rao S, Shenoy M. Plasmapheresis: A retrospective audit of procedures from a tertiary care center in Southern India. Indian J Crit Care Med 2017; 21 (12):857-860.
Introduction: The term plasmapheresis/plasma exchange refers to the removal of the plasma component of blood and its replacement with various fluids. Plasma Exchange (PE) has been used to treat a variety of conditions that are associated with an aberrant immune response. We undertook this retrospective study aiming to look at plasmapheresis procedures conducted in the nephrology department over a fixed time period.
Materials and Methods: Retrospective analysis of PE procedures from January 2013 to October 2016 was conducted in the nephrology and Intensive Care Unit of a tertiary care teaching hospital. The goal was to achieve a total removal of 150–200 ml/plasma per kg body weight. As replacement, we used a standard protocol of 100 ml of 20% albumin in 1 L of normal saline and 2–3 units of fresh frozen plasma. All results were expressed as mean ± standard deviation and statistical analysis was done using the Student\'s t-test for continuous and Fisher\'s exact test for categorical data.
Results: A total of 192 procedures performed on 40 patients (22 males and 18 females). Age ranged from 15 to 79 years with a mean age of 37.5 years. Guillain–Barre syndrome accounted for 67.5% (>two-third of causes) for PE. Vascular access was femoral catheter in 27 (67.5%) and internal jugular catheter in 13 (32.5%). Mild hypotension occurred in 15 procedures (7.8%) of patients and allergic reactions such as rashes and chills occurred in 5 cycles (2.6%). A total of 36 patients (90%) showed significant improvement in condition, 2 did not show any change, while one worsened and one died due to respiratory complications.
Conclusion: Our small series of data of plasmapheresis procedures from nephrology perspective has reaffirmed the safety and efficacy of the therapy in an experienced setup.
Strauss RG, Ciavarella D, Gilcher RO, Kasprisin DO, Kiprov DD, Klein HG, et al. An overview of current management. J Clin Apher 1993;8:189-94.
Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2016;31:149-62.
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 Co-operative Group. Intensive Care Med 1998;24:452-8.
Goto H, Matsuo H, Nakane S, Izumoto H, Fukudome T, Kambara C, et al. Plasmapheresis affects T helper type-1/T helper type-2 balance of circulating peripheral lymphocytes. Ther Apher 2001;5:494-6.
Reeves JH, Butt WW, Shann F, Layton JE, Stewart A, Waring PM, et al. Continuous plasmafiltration in sepsis syndrome. Plasmafiltration in Sepsis Study Group. Crit Care Med 1999;27:2096-104.
Couriel D, Weinstein R. Complications of therapeutic plasma exchange: A recent assessment. J Clin Apher 1994;9:1-5.
Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: Complications and management. Am J Kidney Dis 1994;23:817-27.
van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré study group. N Engl J Med 1992;326:1123-9.
Cortese I, Chaudhry V, So YT, Cantor F, Cornblath DR, Rae-Grant A. Evidence – Based guidelines update. Plasmapheresis in neurologic disorders: Reports of the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology. Neurology 2011;76:294-300.
Basic-Jukic N, Brunetta B, Kes P. Plasma exchange in elderly patients. Ther Apher Dial 2010;14:161-5.
Stegmayr B, Ptak J, Wikström B, Berlin G, Axelsson CG, Griskevicius A, et al. World apheresis registry 2003-2007 data. Transfus Apher Sci 2008;39:247-54.
Srivastava R, Gupta RC, Khatri PC, Lalchandani A. Changing scenario of therapeutic apheresis in India in the last 14 years. Ther Apher 1998;2:317-9.
Vucic S, Davies L. Safety of plasmapheresis in the treatment of neurological disease. Aust N Z J Med 1998;28:301-5.
Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: A prospective study of 1,727 procedures. J Clin Apher 2007;22:270-6.
Sharma RR, Saluja K, Jain A, Dhawan HK, Thakral B, Marwaha N, et al. Scope and application of therapeutic apheresis: Experience from a tertiary care hospital in North India. Transfus Apher Sci 2011;45:239-45.
Gafoor VA, Jose J, Saifudheen K, Musthafa M. Plasmapheresis in neurological disorders: Experience from a tertiary care hospital in South India. Ann Indian Acad Neurol 2015;18:15-9.
Vikrant S, Thakur S, Sharma A, Gupta D, Sharma S. Safety and efficacy of therapeutic membrane plasmapheresis in the treatment of Guillain-Barré syndrome: A study from a tertiary care hospital from India. Neurol India 2017;65:527-31.
Tiwari AK, Bhardwaj G, Aggarwal G, Arora D, Dara RC, Acharya DP, et al. Changing trends in therapeutic plasmapheresis: An Indian perspective. Ther Apher Dial 2017;21:500-6.
Tiwari AK, Dara RC, Pandey P, Arora D, Rawat G, Raina V, et al. Change in therapeutic apheresis practices: Role of continuing medical education (CME). J Clin Apher 2016;31:16-21.