Complications of therapeutic plasma exchange in patients with neurological disorders
Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital.
Methods: This retrospective cross-sectional study evaluated patients with various neurologic disorders receiving TPE in neurology department of Shariati Hospital, Tehran, Iran. Major and minor complications related to TPE were recorded.
Results: Clinical information records of 417 TPE sessions (88 patients) were available. Mean age of patients was 40.0 ± 15.8 years. Underlying diseases included central demyelinating disorders, myasthenia gravis (MG), chronic neuropathy, Guillain-Barre syndrome (GBS), and autoimmune encephalopathy in 34.1%, 33.0%, 17.0%, 14.8%, and 1.1% of patients, respectively. Major complications occurred in 15.9% of patients and 37.5% of patients accounted for minor complications. Among major adverse effects, thrombosis, infection, and life-threatening complications were seen more commonly in patients with central vascular access (P = 0.005, P = 0.003, and P = 0.010, respectively).
Conclusion: TPE complications were seen more commonly in patients with central vascular access. Therefore, use of peripheral vascular access and vigilant patient monitoring by trained health providers can reduce its complications.
2. Schroder A, Linker RA, Gold R. Plasmapheresis for neurological disorders. Expert Rev Neurother 2009; 9(9): 1331-9.
3. Rubenstein MD, Wall RT, Wood GS, Edwards MA. Complications of therapeutic apheresis, including a fatal case with pulmonary vascular occlusion. Am J Med 1983; 75(1): 171-4.
4. Henze T, Prange HW, Talartschik J, Rumpf KW. Complications of plasma exchange in patients with neurological diseases. Klin Wochenschr 1990; 68(23): 1183-8.
5. Reimann PM, Mason PD. Plasmapheresis: Technique and complications. Intensive Care Med 1990; 16(1): 3-10.
6. Gwathmey K, Balogun RA, Burns T. Neurologic indications for therapeutic plasma exchange: 2011 update. J Clin Apher 2012; 27(3): 138-45.
7. Seck SM, Bertrand D, Boucar D. Current indication of plasma exchanges in nephrology: A systematic review. Saudi J Kidney Dis Transpl 2011; 22(2): 219-24.
8. Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: Complications and management. Am J Kidney Dis 1994; 23(6): 817-27.
9. 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(1): 15-9.
10. Kaya E, Keklik M, Sencan M, Yilmaz M, Keskin A, Kiki I, et al. Therapeutic plasma exchange in patients with neurological diseases: Multicenter retrospective analysis. Transfus Apher Sci 2013; 48(3): 349-52.
11. Szczeklik W, Nowak I, Seczynska B, Sega A, Krolikowski W,Musial J. Beneficial therapeutic effect of plasmapheresis after unsuccessfultreatment with corticosteroids in two patients with severe toxic epidermalnecrolysis. Ther Apher Dial 2010; 14(3): 354-7.
12. 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(1): 15-9.
13. Ward DM. Conventional apheresis therapies: A review. J Clin Apher 2011; 26(5): 230-8.
14. Zollner S, Pablik E, Druml W, Derfler K, Rees A, Biesenbach P. Fibrinogen reduction and bleeding complications in plasma exchange, immunoadsorption and a combination of the two. Blood Purif 2014; 38(2): 160-6.
15. Wing EJ, Bruns FJ, Fraley DS, Segel DP, Adler S. Infectious complications with plasmapheresis in rapidly progressive glomerulonephritis. JAMA 1980; 244(21): 2423-6.
16. Pohl MA, Lan SP, Berl T. Plasmapheresis does not increase the risk for infection in immunosuppressed patients with severe lupus nephritis. The Lupus Nephritis Collaborative Study Group. Ann Intern Med 1991; 114(11): 924-9.
17. Parienti JJ, Mongardon N, Megarbane B. Intravascular complications of central venous catheterization by insertion site. J Vasc Surg 2016; 63(3): 846.
18. Salazar E, Garcia S, Miguel R, Segura FJ, Ipe TS, Leveque C. Ultrasound-guided peripheral venous access for therapeutic apheresis procedures reduces need for central venous catheters. J Clin Apher 2017; 32(4): 266-9.