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VOLUME 21 , ISSUE 12 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Plasmapheresis: A retrospective audit of procedures from a tertiary care center in Southern India

O. T. Ahammed Nizar, Pratheeksha Rai, Shobhana Rao, M. Shenoy

Keywords : Complications, dialysis, fluid replacement, plasma exchange

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.

DOI: 10.4103/ijccm.IJCCM_177_17

License: CC BY-ND 3.0

Published Online: 01-07-2013

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

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.


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  1. Kaplan AA. Therapeutic plasma exchange: Core curriculum 2008. Am J Kidney Dis 2008;52:1180-96.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  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.
  7. Couriel D, Weinstein R. Complications of therapeutic plasma exchange: A recent assessment. J Clin Apher 1994;9:1-5.
  8. Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: Complications and management. Am J Kidney Dis 1994;23:817-27.
  9. 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.
  10. 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.
  11. Basic-Jukic N, Brunetta B, Kes P. Plasma exchange in elderly patients. Ther Apher Dial 2010;14:161-5.
  12. 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.
  13. 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.
  14. Vucic S, Davies L. Safety of plasmapheresis in the treatment of neurological disease. Aust N Z J Med 1998;28:301-5.
  15. 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.
  16. Ward DM. Conventional apheresis therapies: A review. J Clin Apher 2011;26:230-8.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
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