Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 19 , ISSUE 1 ( 2015 ) > List of Articles


Therapeutic plasma exchange in the treatment of myasthenia gravis

Sonia Gupta, Rajesh Kumar, S Paul, Amarjit Kaur

Keywords : Adverse reaction, auto antibodies, myasthenia gravis, therapeutic plasma exchange

Citation Information : Gupta S, Kumar R, Paul S, Kaur A. Therapeutic plasma exchange in the treatment of myasthenia gravis. Indian J Crit Care Med 2015; 19 (1):9-13.

DOI: 10.4103/0972-5229.148631

License: CC BY-ND 3.0

Published Online: 01-11-2015

Copyright Statement:  Copyright © 2015; The Author(s).


Aim: The aim of this study was to analyze the retrospective experience related to the indication, complication and outcome of Therapeutic Plasma Exchange (TPE) in Myasthenia gravis (MG). It is a well known autoimmune disease characterized by antibodies against the acetylcholine receptor (anti-ACHR) on the post synaptic surface of the motor end plate. Plasma exchange is the therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence. Materials and Methods: A total of 35 patients of MG were submitted to a total of 41 cycles and 171 session of TPE. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics) by Femoral or central line access and schedule preferably on alternate day interval. Immediate outcome was assessed shortly after each session and overall outcome at discharge. Results: Total of 110 patients of MG who were admitted to our hospital during the study period of two years. 35 (31.8%) patients had TPE performed with mean age of 32 years (M:F = 2:1). The mean number of TPE session was 4.2 (SD±1.2), volume exchange was 2215 ml (SD±435); overall incidence of adverse reaction was 21.7%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 78.3% of patients. Conclusion: TPE may be considered as one of the treatment options especially in developing countries like ours as it is relatively less costly but as effective for myasthenic crisis as other modalities.

PDF Share
  1. Gilcher RO, Smith JW. Apheresis: Principles and technology of hemapheresis. In: Simon TI, Synder EL, Solheim C, Stowell P, Strauss G, Petrides M, editors. Rossi′s Principles of Transfusion Medicine. USA: Wiley-Blackwell; 2009. p. 617-28.
  2. McGrogan A, Sneddon S, de Vries CS. The incidence of myasthenia gravis: A systematic literature review. Neuroepidemiology 2010;34:171-83.
  3. 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.
  4. Assessment of plasmapheresis. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 1996;47:840-3.
  5. Smith JW, Weinstein R, Hillyer KL, AABB Hemapheresis Committee, American Society for Apheresis. Therapeutic apheresis: A summary of current indication categories endorsed by the AABB and the American Society for Apheresis. Transfusion 2003;43:820-2.
  6. Gajdos P, Chevret S, Toyka K. Plasma exchange for myasthenia gravis. Cochrane Database Syst Rev 2002;CD002275.
  7. Lockwood CM, Worlledge S, Nicholas A, Cotton C, Peters DK. Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange. N Engl J Med 1979;300:524-30.
  8. Newsom-Davis J, Wilson SG, Vincent A, Ward CD. Long-term effects of repeated plasma exchange in myasthenia gravis. Lancet 1979;1:464-8.
  9. Heatwole C, Johnson N, Holloway R, Noyes K. Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: An acute hospital cost comparison study. J Clin Neuromuscul Dis 2011;13:85-94.
  10. Zinman L, Ng E, Bril V. IV immunoglobulin in patients with myasthenia gravis: A randomized controlled trial. Neurology 2007;68:837-41.
  11. Murthy JM, Meena AK, Chowdary GV, Naryanan JT. Myasthenic crisis: Clinical features, complications and mortality. Neurol India 2005;53:37-40.
  12. Gajdos P, Chevret S, Clair B, Tranchant C, Chastang C. Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis. Myasthenia Gravis Clinical Study Group. Ann Neurol 1997;41:789-96.
  13. Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans 1990;36:M597-9.
  14. Pinching AJ, Peters DK. Remission of myasthenia gravis following plasma-exchange. Lancet 1976;2:1373-6.
  15. Gajdos P, Chevret S, Toyka KV. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev 2012;12:CD002277.
  16. Yeh JH, Chiu HC, Therapeutic Apheresis Registry Group in Taiwan. Therapeutic apheresis in Taiwan. Ther Apher 2001;5:513-6.
  17. Carandina-Maffeis R, Nucci A, Marques JF Jr, Roveri EG, Pfeilsticker BH, Garibaldi SG, et al. Plasmapheresis in the treatment of myasthenia gravis: Retrospective study of 26 patients. Arq Neuropsiquiatr 2004;62:391-5.
  18. Werneck LC, Scola RH, Germiniani FM, Comerlato EA, Cunha FM. Myasthenic crisis: Report of 24 cases. Arq Neuropsiquiatr 2002;60:519-26.
  19. Rodnitzky RL, Bosch EP. Chronic long-interval plasma exchange in myasthenia gravis. Arch Neurol 1984;41:715-7.
  20. Madore F. Plasmapheresis. Technical aspects and indications. Crit Care Clin 2002;18:375-92.
  21. Kiprov DD, Golden P, Rohe R, Smith S, Hofmann J, Hunnicutt J. Adverse reactions associated with mobile therapeutic apheresis: Analysis of 17,940 procedures. J Clin Apher 2001;16:130-3.
  22. Kaplan AA. Therapeutic plasma exchange: A technical and operational review. J Clin Apher 2013;28:3-10.
  23. Korach JM, Petitpas D, Paris B, Bourgeade F, Passerat V, Berger P, et al. Plasma exchange in France: Epidemiology 2001. Transfus Apher Sci 2003;29:153-7.
  24. Seggia JC, Abreu P, Takatani M. Plasmapheresis as preparatory method for thymectomy in myasthenia gravis. Arq Neuropsiquiatr 1995;53:411-5.
  25. Lazo-Langner A, Espinosa-Poblano I, Tirado-Cárdenas N, Ramírez-Arvizu P, López-Salmorán J, Peñaloza-Ramírez P, et al. Therapeutic plasma exchange in Mexico: Experience from a single institution. Am J Hematol 2002;70:16-21.
  26. Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML, 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 sixth special issue. J Clin Apher 2013;28:145-284.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.