Safety and tolerability of therapeutic plasma exchange in autoimmune neurological diseases — a retrospective single-centre analysis
, 2, 3, 1, 13
Abstract
Clinical rationale for study. The sudden onset of autoimmune neurological diseases often threatens life. In such clinical situations, fast, effective and safe treatment is needed. Therapeutic plasma exchange (TPE) is an option in the treatment of autoimmune disorders.
Aim of study. The aim was to assess the tolerability and safety of membrane-based therapeutic plasma exchange (mTPE) in patients with autoimmune neurological diseases.
Materials and methods. A total of 410 TPE treatments were performed in 91 adult patients. The main reasons for performing TPE were: Guillain-Barre syndrome (39.56%), chronic inflammatory demyelinating polyradiculoneuropathy (20.88%), and myasthenia gravis (17.58%).
Results. A total of 183 (44.6%) mTPE treatments were performed without complications. In 18 (19.8%) patients, there were no complications observed in any of the mTPE procedures (a total of 83 procedures). Serious and life-threatening complications occurred during four (0.97%) mTPEs. The most common abnormality in laboratory tests was hypocalcaemia. In patients with a fibrinogen c oncentration ≥ 2 .63 g /L, m easured before the second plasmapheresis, coagulation in the TPE filter was more f requently o bserved (p = 0 .04).
Conclusions and clinical implications. Our study proves that the use of plasmapheresis conducted by filtration in the treatment of autoimmune neurological diseases is safe and well tolerated.
Keywords: autoimmune neurological diseasestherapeutic plasma exchangeefficacyside effects
References
- Sokolov AA, Solovyev AG. Russian pioneers of therapeutic hemapheresis and extracorporeal hemocorrection: 100-year anniversary of the world's first successful plasmapheresis. Ther Apher Dial. 2014; 18(2): 117–121.
- Padmanabhan A, Connelly-Smith L, Aqui N, 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 Eighth Special Issue. J Clin Apher. 2019; 34(3): 171–354.
- Mörtzell Henriksson M, Newman E, Witt V, et al. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci. 2016; 54(1): 2–15.
- Jani-Acsadi A, Lisak RP. Myasthenic crisis: guidelines for prevention and treatment. J Neurol Sci. 2007; 261(1-2): 127–133.
- Guptill JT, Oakley D, Kuchibhatla M, et al. A retrospective study of complications of therapeutic plasma exchange in myasthenia. Muscle Nerve. 2013; 47(2): 170–176.
- Weinshenker BG, O'Brien PC, Petterson TM, et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol. 1999; 46(6): 878–886.
- Wood L, Jacobs P. The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels. J Clin Apher. 1986; 3(2): 124–128.
- Gashti CN, Andreoli DC, Patel D. Membrane-based therapeutic plasma exchange (mTPE): Technical and clinical experience. J Clin Apher. 2018; 33(1): 38–45.
- Córdoba JP, Larrarte C, Medina MC. Experience in therapeutic plasma exchange by membrane filtration at an academic center in Colombia: Registry of the first 500 sessions. J Clin Apher. 2015; 30(6): 347–352.
- Ibrahim RB, Liu C, Cronin SM, et al. Drug removal by plasmapheresis: an evidence-based review. Pharmacotherapy. 2007; 27(11): 1529–1549.
- Szczeklik W, Jankowski M, Wegrzyn W, et al. Acute respiratory failure in patients with Guillain-Barré syndrome and myasthenic crisis treated with plasmapheresis in the intensive care unit. Pol Arch Med Wewn. 2008; 118(4): 239–242.
