1
|
Park JH, Kim HW, Chung HJ, Kim H. A nationwide population-based study on therapeutic plasma exchange for 10 years in Korea using Health Insurance Review and Assessment database. J Clin Apher 2021; 36:831-840. [PMID: 34463973 DOI: 10.1002/jca.21935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/09/2021] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Indications for therapeutic plasma exchange (TPE) have expanded over the years, and the number of procedures is expected to have been increased. Apheresis registries can be difficult to sustain due to workload and privacy issues. This study aimed to analyze national claims data to characterize the use of TPE. MATERIALS AND METHODS Patients who underwent TPE were retrospectively identified between January 2008 and December 2017 from the Korean Health Insurance Review and Assessment Service database. Data of patients' characteristics, primary diagnosis, hospitalization, treatment, and procedures were analyzed. RESULTS A total of 9944 patients underwent 62 606 TPE procedures. The median number of TPE procedures performed per patient was 5 (interquartile range, 3-7). Fresh frozen plasma (71.4%) was most commonly used as the replacement fluid. The most common indication was renal diseases (36.8%), followed by hepato-biliary (17.6%) and hematological (15.2%) diseases. Increased frequency of renal diseases was the most remarkable change, which increased from 529 (21.2%) procedures in 2008 to 4107 (44.5%) procedures in 2017, reflecting the widespread implementation of ABO-incompatible kidney transplantation. The top five hospitals conducted 59.6% of the procedures, which showed a centralized distribution. CONCLUSIONS The most common indication was renal diseases. The number of TPE procedures performed annually increased by approximately 3.7 times from 2008 to 2017. This study shows that other than a registry, claims data can be successfully used to analyze various aspects of TPE procedures on a nationwide scale. This approach could be used by other countries, especially those that have national health insurance.
Collapse
Affiliation(s)
- Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Hee-Jung Chung
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
2
|
Zantek ND, Martinez RJ, Johnson AD, Tholkes AJ, Shah S. Apheresis practice patterns in the United States of America: Analysis of a market claims database. J Clin Apher 2021; 36:750-758. [PMID: 34252989 DOI: 10.1002/jca.21926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Indications for apheresis procedures are expanding; however, the evidence for many is low quality. A better understanding of apheresis patterns in the United States is needed to better plan prospective research studies. METHODS Data from January 1, 2013, to September 30, 2015, were analyzed from the IBM MarketScan Research Databases of de-identified health insurance claims data of several million enrollees at all levels of care from large employers and health plans across the United States. Apheresis procedures were identified by International Classification of Diseases, Ninth version (ICD-9) and Current Procedure Terminology (CPT) codes. RESULTS Combining inpatients and outpatients, 18 706 patients underwent 70 247 procedures. The patients were 52.7% female, 5.1% <18 years, and 55.9% inpatient, while the procedures were 49.5% female, 5.7% <18 years, and 19.8% inpatient. For each apheresis modality, the percent of patients treated and procedures performed, respectively, are plasmapheresis 36.4% and 42.5%, autologous harvest of stem cells 22.8% and 10.7%, plateletpheresis 11.1% and 3.5%, allogeneic harvest of stem cells 8.2% and 2.5%, photopheresis 5.4% and 24.4%, erythrocytapheresis 3.8% and 4.7%, leukopheresis 2.0% and 0.7%, immunoadsorption 1.4% and 0.4%, extracorporeal selective adsorption/filtration and plasma reinfusion 1.0% and 3.6%, and other 21.6% and 6.9%. A wide variety of diagnoses were treated; however, analysis of the diagnoses suggests the procedure codes may not always reflect an apheresis procedure. CONCLUSION This study describes the landscape of apheresis in the United States, but may overestimate some procedures based on linked diagnosis codes. Direct measures of apheresis procedures are needed to plan future research studies.
Collapse
Affiliation(s)
- Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ryan J Martinez
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew D Johnson
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anthony J Tholkes
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Surbhi Shah
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Williams LA, Arnesen C, Gunn C, Boshell MN, Pham HP, Guillory B, Adamski J, Marques MB. New subcutaneous PowerFlow port results in cost and time‐savings in a busy outpatient apheresis clinic. J Clin Apher 2018; 34:482-486. [DOI: 10.1002/jca.21678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lance A. Williams
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Christine Arnesen
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Christina Gunn
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Michael N. Boshell
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Huy P. Pham
- Department of PathologyKeck School of Medicine of the University of Southern California Los Angeles California
| | - Bryan Guillory
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Jill Adamski
- Department of Laboratory Medicine and PathologyMayo Clinic Phoenix Arizona
| | - Marisa B. Marques
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| |
Collapse
|
4
|
Abstract
Therapeutic plasma exchange is an apheresis modality in which plasma is separated from the blood cellular components ex vivo, discarded, and replaced with an isosmotic fluid (most commonly 5% albumin) to maintain appropriate oncotic pressure in the patient. Therapeutic plasma exchange is used in the treatment of many diseases and indications. The recent seventh edition of the American Society for Apheresis guidelines indicates approximately 72 diseases and 116 indications for which therapeutic plasma exchange may be effective. One of the critical aspects for the successful performance of therapeutic plasma exchange is appropriate vascular access to provide high blood flow for the collection and return phases of the procedure, especially because most patients who need therapeutic plasma exchange will require more than one treatment over days to weeks. This article provides an overview of the characteristics of therapeutic plasma exchange, the clinical diseases and indications that may be treated with therapeutic plasma exchange, and the different types of vascular access employed, with their advantages and disadvantages. The latter may include peripheral venous access and intravascular or implantable access devices, such as arteriovenous grafts and fistulas, central venous catheters, and central venous catheters tunneled with ports.
Collapse
Affiliation(s)
- Tina S Ipe
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Marisa B Marques
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Alabama
| |
Collapse
|
5
|
Sirignano RM, Paden ML, Fasano R, Meyer EK. Epidemiology of therapeutic apheresis with a multidisciplinary approach at a high volume pediatric center. J Clin Apher 2017; 33:297-302. [PMID: 29139162 DOI: 10.1002/jca.21604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/28/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Therapeutic apheresis (TA) is used inconsistently in pediatric populations. We seek to define our multidisciplinary institutional practice. METHODS We conducted a retrospective chart review of patients receiving TA from January 1, 2012 through October 31, 2015. Data collected included demographics, American Society of Apheresis (ASFA) indication, complications, and mortality. RESULTS Over 46 months, 1198 TA procedures were conducted on 289 patients ranging in age from 5 months to 21 years with weights ranging from 4.76 to 170.3 kg (16 procedures in patients <10 kg). The procedures were 86% therapeutic plasma exchange, 10% red blood cell exchange, 4% extracorporeal photopheresis, and 5 leukocytapheresis procedures. TA was initiated in different clinical environments: 41% outpatient, 37% intensive care, 15% general inpatient, and 7% operating room. The ASFA category (6th edition) indications for the 1198 procedures included: 44% category I, 25% category II, 23% category III, a single category IV procedure, and the remainder (8%) uncategorized by ASFA. The rate of procedure failure and procedure-related mortality are 1 and 0%, respectively. Case mortality rate was 4%. CONCLUSION At a large volume pediatric hospital, TA is commonly used and can be performed safely in a variety of settings by a multidisciplinary team. This demographic review catalogs the number and type of procedures performed as a second-line therapy or on the basis of limited evidence. Additional collaborative investigation is needed to evaluate unique implications of TA in pediatrics to maximize efficacy while preserving safety.
Collapse
Affiliation(s)
- Rachel M Sirignano
- Department of Pediatrics, Emory University, Atlanta, Georgia.,Division of Critical Care, Emory University, Atlanta, Georgia.,Department of Advanced Technology, Children's Healthcare of Atlanta, Georgia
| | - Matthew L Paden
- Department of Pediatrics, Emory University, Atlanta, Georgia.,Division of Critical Care, Emory University, Atlanta, Georgia.,Department of Advanced Technology, Children's Healthcare of Atlanta, Georgia
| | - Ross Fasano
- Department of Pathology, Emory University, Atlanta, Georgia
| | - Erin K Meyer
- Department of Pathology, Emory University, Atlanta, Georgia.,Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
6
|
Blaha M, Lanska M, Tomsova H, Zak P. Apheresis data registration in WWA registry-10-year experience of our center. Transfus Apher Sci 2017; 56:738-741. [PMID: 28951112 DOI: 10.1016/j.transci.2017.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/17/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The WAA Registry allows detailed registration of hemapheresis data. Our center registers results there as well. We summarize our results as compared to those of the WAA Registry. MATERIALS AND METHODS Hemapheresis results are registered in the WAA Registry in Umea, Sweden. The patients' identity is protected by coding. General data (age, gender, weight, procedure, technique used etc.) or special data (occurrence and type of adverse reactions, health condition, quality of life etc.) are completed in a pre-defined form. RESULTS In 2006-2016, we registered 7,927 hemaphereses in 956 patients in the WAA Registry; 40.4% in men and 59.6% in women aged 53±15years. There were mostly no significant differences in the individual interventions between our center and the WAA Registry; only the share of cascade filtrations/rheophereses is quite different (9 times higher in our center - 18.2% of interventions as compared to 2.1% in the WAA Registry). The share of photophereses (32.1%) is relatively high - due to cooperation with the bone marrow transplantations department. DISCUSSION AND CONCLUSION In regular quality assessment, one center usually does not have enough data and experience with some diseases or interventions; therefore, comparison with the WAA Registry results is valuable not only for the quality of interventions but also for side effect prevention. On the other hand, the advantage is that every center has its unique code and may work quite independently (quick and independent non-competitive assessments). Five-minute duration of registration is advantageous in a time-demanding work; moreover, the registration is free.
Collapse
Affiliation(s)
- M Blaha
- Charles University, Medical Faculty, Sokolskastreet 451, 500 05 Hradec Kralove, Czech Republic.
| | - M Lanska
- Charles University, Medical Faculty, Sokolskastreet 451, 500 05 Hradec Kralove, Czech Republic
| | - H Tomsova
- Charles University, Medical Faculty, Sokolskastreet 451, 500 05 Hradec Kralove, Czech Republic
| | - P Zak
- Charles University, Medical Faculty, Sokolskastreet 451, 500 05 Hradec Kralove, Czech Republic
| |
Collapse
|
7
|
Cid J, Carbassé G, Cid-Caballero M, López-Púa Y, Alba C, Perea D, Lozano M. The Barcelona Hospital Clínic therapeutic apheresis database. J Clin Apher 2017; 33:259-264. [DOI: 10.1002/jca.21587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/03/2017] [Accepted: 09/06/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis; ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona; Barcelona Spain
| | - Gloria Carbassé
- Apheresis Unit, Department of Hemotherapy and Hemostasis; ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona; Barcelona Spain
| | | | - Yolanda López-Púa
- Department of Preventive Medicine and Epidemiology; ICMiD, Hospital Clínic, University of Barcelona, ISGlobal; Barcelona Spain
| | - Cristina Alba
- Apheresis Unit, Department of Hemotherapy and Hemostasis; ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona; Barcelona Spain
| | - Dolores Perea
- Apheresis Unit, Department of Hemotherapy and Hemostasis; ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona; Barcelona Spain
| | - Miguel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis; ICMHO, IDIBAPS, Hospital Clínic, University of Barcelona; Barcelona Spain
| |
Collapse
|
8
|
Mann SA, Williams LA, Marques MB, Pham HP. Hospital-acquired anemia due to diagnostic and therapy-related blood loss in inpatients with myasthenia gravis receiving therapeutic plasma exchange. J Clin Apher 2017; 33:14-20. [PMID: 28574188 DOI: 10.1002/jca.21554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Daily laboratory testing (DLT) is an important cause of iatrogenic anemia. Therapeutic plasma exchanges (TPE) represent another source of blood loss. This study investigated the contributions of DLT and TPE to changes in hemoglobin of inpatients with myasthenia gravis (MG) exacerbation. STUDY DESIGN AND METHODS All admissions for MG that included TPE between 2008 and 2012 were identified. The DLT- and TPE-related blood losses per patient were estimated based on the number of laboratory tests and TPE procedures. The primary endpoint was the difference between the discharge hemoglobin (Hgb) and the admission Hgb (ΔHgb). Univariate and multivariable analyses were used to identify clinical predictors of ΔHgb. RESULTS A total of 46 patients (52% male, average age of 58 years) had 90 hospitalizations and underwent 424 TPEs during the study-period. Their average length of stay (LOS) was 10.4 days, and total DLT and TPE-related blood losses were 107 and 94 mL, respectively. While 41% of patients were anemic on admission, 90% were anemic at discharge. The average ΔHgb was -2.2 g/dL. The patient's blood volume, renal function, admission number, LOS, and combined blood losses correlated with ΔHgb by linear regression, but only DLT was an independent predictor of ΔHgb in the multivariable analysis. CONCLUSION Approximately 50% of MG patients admitted for TPE developed hospital-acquired anemia, which was directly correlated with the volume of blood collected for laboratory tests. A variety of strategies to reduce DLT could circumvent this iatrogenic complication.
Collapse
Affiliation(s)
- Steven A Mann
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lance A Williams
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marisa B Marques
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Huy P Pham
- Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
9
|
Apheresis Medicine education in the United States of America: State of the discipline. Transfus Apher Sci 2017; 56:1-5. [DOI: 10.1016/j.transci.2016.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Raval JS, Mazepa MA, Whinna HC, Park YA. Monitoring therapeutic apheresis utilization: Database versus registry. J Clin Apher 2016; 32:208-209. [DOI: 10.1002/jca.21483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/01/2016] [Accepted: 06/16/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jay S. Raval
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill NC
| | - Marshall A. Mazepa
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill NC
| | - Herbert C. Whinna
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill NC
| | - Yara A. Park
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill NC
| |
Collapse
|