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Coirier V, Lesouhaitier M, Reizine F, Painvin B, Quelven Q, Maamar A, Gacouin A, Tadié JM, Le Tulzo Y, Camus C. Tolerance and complications of therapeutic plasma exchange by centrifugation: A single center experience. J Clin Apher 2021; 37:54-64. [PMID: 34786746 DOI: 10.1002/jca.21950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) constitutes an important therapy for hematological, neurological, immunological, and nephrological diseases. Most studies have focused on efficacy, whereas tolerance and complications during sessions have been less well studied and not recently. MATERIAL AND METHODS We conducted a single center retrospective study of all patients who underwent TPE between 2011 and 2018. TPE sessions using the centrifugation technique were performed by dedicated trained nurses. Specific side effects were identified through surveillance forms completed contemporaneously. The primary outcome was the rate of all-type adverse effects that occurred during the TPE sessions. RESULTS In total, 1895 TPE sessions performed on 185 patients were analyzed. At least one adverse effect was reported for 805 sessions (42.5% [29.9%-70.1%]), corresponding to 171 patients (92.4% [87.6%-95.8%]). Hypotension occurred during 288 sessions (15.2%), was asymptomatic in 95.8% of cases, and more frequent with the use of 4% albumin than fresh frozen plasma (FFP) (19.8 vs 8.9%, P <.0001). Hypocalcemia occurred during 370 sessions (19.6%) and was more frequent with the use of FFP than with the use of albumin alone (FFP alone: 28.0%, albumin + FFP: 26%, albumin alone: 11.7%; P <.0001). Allergic reactions occurred during 56 sessions (3%), exclusively with FFP. Severe adverse effects were reported for 0.3% of sessions and 5.4% of patients. CONCLUSIONS TPE is a safe therapy when performed by a trained team. Adverse effects were frequent but mostly not serious. The replacement fluid was the main determinant of the occurrence of complications. (ClinicalTrials.gov ID: NCT03888417).
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Affiliation(s)
- Valentin Coirier
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Mathieu Lesouhaitier
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Florian Reizine
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Benoît Painvin
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Quentin Quelven
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Adel Maamar
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Jean-Marc Tadié
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Yves Le Tulzo
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
| | - Christophe Camus
- Maladies Infectieuses et Réanimation Médicale, CHU de Rennes, Rennes, France.,Faculté de Médecine, Université de Rennes 1, Rennes, France
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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.
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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
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Brunetta Gavranić B, Bašić-Jukić N, Premužić V, Kes P. Membrane therapeutic plasma exchange with and without heparin anticoagulation. J Clin Apher 2017; 32:479-485. [DOI: 10.1002/jca.21544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/20/2017] [Accepted: 03/25/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Bruna Brunetta Gavranić
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Nikolina Bašić-Jukić
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Vedran Premužić
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
| | - Petar Kes
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation; University Hospital Centre Zagreb; Zagreb Croatia
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Distribution of indications and procedures within the framework of centers participating in the WAA apheresis registry. Transfus Apher Sci 2017; 56:71-74. [DOI: 10.1016/j.transci.2016.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Huart A, Josse AG, Chauveau D, Korach JM, Heshmati F, Bauvin E, Cointault O, Kamar N, Ribes D, Pourrat J, Faguer S. Outcomes of patients with Goodpasture syndrome: A nationwide cohort-based study from the French Society of Hemapheresis. J Autoimmun 2016; 73:24-9. [DOI: 10.1016/j.jaut.2016.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
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Mörtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Rock G, Ptak J, Blaha M, Lanska M, Gasova Z, Hrdlickova R, Ramlow W, Prophet H, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout S, Aandahl A, Sikole A, Tomaz J, Lalic K, Mazic S, Strineholm V, Brink B, Berlin G, Dykes J, Toss F, Axelsson CG, Stegmayr B, Nilsson T, Norda R, Knutson F, Ramsauer B, Wahlström A. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci 2016; 54:2-15. [PMID: 26776481 DOI: 10.1016/j.transci.2016.01.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.
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Affiliation(s)
| | - E Newman
- Bone Marrow Transplant & Apheresis, New South Wales, Australia
| | - V Witt
- St. Anna, Vienna, Austria
| | | | | | | | | | | | | | - J Ptak
- Frydek-Mistek, Czech Republic
| | - M Blaha
- Hradec Kralove, Czech Republic
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Driss F, Saheb S, Garraud O, Heschmati F. [When transfusion and hemapheresis are medicine]. Presse Med 2015; 44:221-6. [PMID: 25637111 DOI: 10.1016/j.lpm.2014.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 07/07/2014] [Indexed: 11/29/2022] Open
Abstract
Blood transfusion frequently consists in bringing blood components in patients presenting with global deficiency of cells or of certain factors allowing, i.e. hemostasis or oxygenation; transfusion is thus performed on a short period, or on a period that corresponds to the recovery of the bone marrow (that is deficient either quantitatively or qualitatively). In some other circumstances, patients must receive transfusions as the one treatment of their pathology; this can be for life, when the deficiency has a genetic origin, or episodically in the case of autoimmune disorders. Once hemotherapy is initiated, one must appreciate the balance between the benefits and the risks or overload, and adjust with subtractions and exchanges (of blood components). This paper presents examples of two cases: hemotherapy in sickle cell patients, and patients undergoing plasma exchange programs.
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Affiliation(s)
- Françoise Driss
- Hôpitaux universitaires de Paris Sud-Bicêtre, unité de thérapeutique transfusionnelle, 94275 Le Kremlin-Bicêtre, France.
| | - Samir Saheb
- Groupe hospitalier La Pitié-Salpêtrière-Charles-Foix, centre clinique d'hémobiothérapie, service d'hématologie, 75013 Paris, France
| | - Olivier Garraud
- Institut national de la transfusion sanguine, 75015 Paris, France; Université de Lyon, faculté de médecine, 42023 Saint-Étienne, France
| | - Farhad Heschmati
- Hôpitaux universitaires de Paris, centre Cochin, unité de thérapeutique transfusionnelle, 75014 Paris, France; Société française d'hémaphérèse, 75000 Paris, France
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Kumar R, Birinder SP, Gupta S, Singh G, Kaur A. Therapeutic plasma exchange in the treatment of myasthenia gravis. Indian J Crit Care Med 2015; 19:9-13. [PMID: 25624644 PMCID: PMC4296418 DOI: 10.4103/0972-5229.148631] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Rajesh Kumar
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Paul Birinder
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sonia Gupta
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Amarjit Kaur
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Morales Borges RH, Nieves GC, Martínez MR, Ramos RV, Pedraza Otero LI, Vargas CN, Pedraza GO, Jiménez JJM. Therapeutic aphaeresis: Experience in Puerto Rico. Transfus Apher Sci 2014; 50:473-8. [DOI: 10.1016/j.transci.2014.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/22/2014] [Accepted: 02/24/2014] [Indexed: 11/25/2022]
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Haque A, Sher G, Hoda M, Moiz B. Feasibility of pediatric plasma apheresis in intensive care settings. Ther Apher Dial 2014; 18:497-501. [PMID: 24674133 DOI: 10.1111/1744-9987.12173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Therapeutic plasma apheresis or exchange (TPE) in the pediatric population is technically challenging. Moreover, there is generally an apprehension in using TPE in children compared to adults. Recently, usage of TPE has evolved and is now being used in heterogenous clinical conditions. Its usefulness is classified by the American Society for Apheresis (ASFA) into various categories ranging from I to IV. The objective of this paper was to review the procedure in context of clinical indications, complications and outcomes in children. For this purpose, we retrospectively reviewed all TPE procedures performed on inpatients of 3 to 16 years of age during a 6-year period (2007-2012). A total of 130 procedures were performed on 28 patients (M : F ratio of 1:1) with median age (range) of 8.8 (4-16) years. All procedures were done using the continuous cell-separator centrifugal method. Due to organ dysfunctions, the majority of procedures (N = 26 of 28 or 92% patients) were performed in the pediatric intensive care unit. Twenty-three, four and one patient belonged to ASFA categories I, II and III, respectively. The most common indications were neurological disorders (N = 13 or 46.4%), comprised of Guillain-Barré syndrome (N = 10) and myasthenia gravis (N = 3). Hematological disorders (N = 10 or 35.7%) including thrombotic thrombocytopenic purpura-hemolytic uremic syndrome were a close second. Complete recovery was seen in 23 patients (84%). Trivial adverse effects were observed in 18/130 (13.8%) procedures. Major complications including cardiac arrest, hypotension and transfusion-related acute lung injury were observed in 5/130 or 3.8% of procedures. However, there was no procedure-related death though five patients died during treatment due to underlying pathology. In conclusion, TPE is a safe and effective option in sick children for appropriate indications. An experienced staff with sound procedural skills is imperative for successful therapy.
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Affiliation(s)
- Anwarul Haque
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Guptill JT, Oakley D, Kuchibhatla M, Guidon AC, Hobson-Webb LD, Massey JM, Sanders DB, Juel VC. A Retrospective study of complications of therapeutic plasma exchange in myasthenia. Muscle Nerve 2012; 47:170-6. [DOI: 10.1002/mus.23508] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 11/12/2022]
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Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study. J Clin Neuromuscul Dis 2012; 13:85-94. [PMID: 22361692 DOI: 10.1097/cnd.0b013e31822c34dd] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the short-term financial costs of treating a patient in myasthenia gravis crisis with intravenous immunoglobulin (IVIG) versus plasma exchange. METHODS An itemized comparative cost-minimization analysis of IVIG versus plasma exchange for myasthenia gravis crisis was performed. Calculations were based on each therapy's implementation cost, associated hospitalization times, and predicted cost to treat known complications. A cost superiority determination was proposed based on the total cost profile of each therapy. RESULTS The difference in total cost favored IVIG over plasma exchange with an average savings of $22,326 per patient. Sensitivity analysis demonstrated that overall costs are highly dependent on IVIG dosing, hospital lengths of stay, and the number of plasma exchange days required. CONCLUSIONS The use of IVIG for myasthenia gravis crisis may be a short-term cost minimizing therapy compared with plasma exchange. Additional prospective studies are required to evaluate the extended cost profile and efficacy of these therapies.
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Kadikoylu G, Yavasoglu I, Ozkul A, Akyol A, Yukselen V, Guney E, Bolaman Z. The single center registry for therapeutic apheresis in Turkey: 11-year activity. Transfus Apher Sci 2012; 47:61-5. [DOI: 10.1016/j.transci.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Brunetta Gavranić B, Bašić-Jukić N, Kes P. Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia. Ther Apher Dial 2011; 15:587-92. [DOI: 10.1111/j.1744-9987.2011.00986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mokrzycki MH, Balogun RA. Therapeutic apheresis: a review of complications and recommendations for prevention and management. J Clin Apher 2011; 26:243-8. [PMID: 21898573 DOI: 10.1002/jca.20303] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/05/2011] [Indexed: 01/17/2023]
Abstract
Therapeutic apheresis procedures are a form of extracorporeal therapy that use different techniques to separate blood into the different components out of which the part containing the etiological agent in a disease process is discarded and the rest of the components of blood are re-infused into the patient, frequently with the addition of a replacement fluid or volume. These complex procedures have inherent risks of adverse events and factors that may impact on the incidence these events include the underlying disease state, anticoagulation techniques, replacement fluid type including the volume, issues related to the vascular access used, and the therapeutic apheresis procedure type and technique. We present a representative case based review of common complications of therapeutic apheresis and suggestions about how to prevent or manage these as presented at the 2010 Therapeutic Apheresis Academy.
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Affiliation(s)
- Michele H Mokrzycki
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Shahidi S, Memarzadeh M, Kamali M, Naini AE. Trend of indications for therapeutic plasma exchange at an Iranian university hospital. Transfus Apher Sci 2011; 44:119-22. [DOI: 10.1016/j.transci.2011.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/20/2011] [Indexed: 12/19/2022]
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Okafor C, Ward DM, Mokrzycki MH, Weinstein R, Clark P, Balogun RA. Introduction and overview of therapeutic apheresis. J Clin Apher 2011; 25:240-9. [PMID: 20806281 DOI: 10.1002/jca.20247] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chidi Okafor
- Department of Medicine, Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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Abstract
OBJECTIVES Seventy-five centers from many countries have applied for a login code to the WAA apheresis registry. Fifteen centers from 7 countries have been actively entering data at the internet site from 2003 until 2007. We report on data from the registry so far. METHODS This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 2013 patients (12,448 procedures) have been included. A median of 6 treatments have been performed (range 1-140). Mean age 51 years (range 1-94 years; 45% women). Seven percent of the patients were < or = 21 years and 4% were < or = 16 years. RESULTS The purpose of the apheresis procedure was therapeutic in 67% and retrieval of blood components in 33%. Main indications: neurological and hematological diseases, lipid apheresis and stemcell collection (autologous, and some allogeneic). Blood access: peripheral vessels (71%), central dialysis catheter through jugular (6.5%) or subclavian veins (6.7%), femoral vein (8%) and AV fistula (4%). ACD was used for anticoagulation in 73% of the procedures. Albumin was mainly used as replacement fluid. Adverse events (AE) were registered in 5.7% of the procedures. AE was graded as mild (2.5%), moderate (2.7%) or severe (0.5%). No death occurred due to treatment. The procedures were interrupted in 2.6%. Most frequent AEs were blood access problems (29%), tingling around the mouth (20%), hypotension (18%), and urticaria (9%). There were significant differences between the centers regarding mild and moderate AEs. Data indicate that centers using continuous infusion of calcium had fewer AEs. CONCLUSION There was a limited number of severe AEs. Centers use various standard procedures for apheresis. By learning from the experience of others the treatment quality will improve further. In the near future, an update of the registry will enable more extensive evaluation of the data.
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Norda R, Axelsson CG, Axdorph U, Berlin G, Wikström B, Stegmayr B. Recognition of Intercenter Differences May Help Develop Best Practice. Ther Apher Dial 2008; 12:347-54. [DOI: 10.1111/j.1744-9987.2008.00608.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Establishment of a national on-line registry for apheresis in Korea. Transfus Apher Sci 2008; 38:93-100. [DOI: 10.1016/j.transci.2008.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 10/10/2007] [Accepted: 01/11/2008] [Indexed: 11/17/2022]
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Abstract
Management of myasthenic crisis (MC) requires admission of the patient into a neurological intensive care unit and timely institution of an efficient and safe treatment. Despite the growing clinical experience with disease modifying immunotherapy there is no clinical consensus regarding the use of plasma exchange or high dose immunoglobulin treatment in an ICU setting. The choice of treatment modalities seem to rely mostly on institutional preferences primarily due to a lack of well-designed clinical trials comparing currently available therapeutic options. In our experience and based on a review of recent literature we advocate the use of plasma exchange (PE) as a primary modality in the acute care setting, supported by other immunomodulatory medications such as corticosteroids. Pharmacological management cannot substitute for adequate intensive care management of the respiratory and bulbar insufficiency associated with MC. Every effort should be done to prevent myasthenic exacerbation/crisis and to develop a maintenance management that leads to effective prevention.
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Yavasoglu I, Kadikoylu G, Akyol A, Bolaman Z. Therapeutic apheresis: Results from a single center in Turkey. Transfus Apher Sci 2007; 36:249-53. [PMID: 17556022 DOI: 10.1016/j.transci.2007.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 01/12/2007] [Accepted: 02/12/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes. AIM We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006. METHODS A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis. RESULTS While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain. CONCLUSION TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.
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Affiliation(s)
- Irfan Yavasoglu
- Adnan Menderes University Medical Faculty, Divisions of Hematology, 09100 Aydin, Turkey.
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Jákó J, Komoly S, Soltész P. [Plasmapheresis treatment in systemic autoimmune disorders]. Orv Hetil 2007; 148 Suppl 1:72-6. [PMID: 17430798 DOI: 10.1556/oh.2007.28039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is necessary to rethink, from time to time, the efficacy of various treatment methods and, consequently, their place in the curing of certain pathological conditions. History of the development of methods throws a light on the fact that it is not always a question to be solved that brings about research; but there are cases when a technique realized for a totally different purpose is being used as a therapeutic process. In autoimmune illnesses, the plasmapheresis therapy is not of recent origin; in spite of that, however, a number of experiences, collected in the treatment of illnesses having divergent pathological symptoms, is not sufficient in itself to establish effectiveness without random double-blind tests. Intervention trying to obtain results under any circumstances (heroic medicine) is to be avoided. When evaluating results in general, however, we must take into consideration the proportion of costs also (cost/benefit principle).
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Affiliation(s)
- János Jákó
- Országos Gyógyintézeti Központ, Belgyógyászati Osztály, Budapest, Hungary.
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Stegmayr B, Ptak J, Wikström B. World apheresis registry report. Transfus Apher Sci 2007; 36:13-6. [PMID: 17234456 DOI: 10.1016/j.transci.2006.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 06/03/2006] [Indexed: 10/23/2022]
Abstract
UNLABELLED The establishment of national apheresis registries has been helpful to learn about therapeutic profiles and adverse event incidences. During 2003, the World Apheresis Registry was established and centers from all countries were invited to participate to register their apheresis activities (at www.iml.umu.se/medicin). MATERIAL In this paper, we will report and analyze the first data retrieved from three centers, in 2 European countries, that registered a total of 388 therapeutic apheresis treatments in 122 patients, 95% due to acute indications. Statistical analyses were performed using an independent Student t-test and Fisher's test. A p-value of less than 0.05 was considered significant. RESULTS Fifty percent of the treated patients were women. The mean age of the patients was 51 years (+/-17, range 16-84) and there was no difference between genders (w 50.4, m 51.6 years). Diagnoses for treatment were mainly neurological and vasculitis. In 63% peripheral access was used with a central double lumen catheter, 22% in the jugular vein, 8% in the subclavian vein and 6% the femoral vein. Significant inter-center differences were seen in regard to the access used. The main technique used was centrifugation for conventional plasma exchange (86%), while other modes were leukapheresis, erythrapheresis, platelet apheresis, LDL-apheresis and adsorption of antibodies. Citrate was the only anticoagulant in 92%. During plasma exchange procedures using centrifugation, replacement was by albumin only (58%) or plasma, the latter often in combination with albumin (42%). Adverse events (AEs) were noted in 11% of the procedures. Patients with hypocalcaemia side effects with tingling sensations were included in those data as mild AE and as moderate AEs if they received calcium (Ca) medication. No patient died due to adverse effects. A mild AE was present in 1.8% and moderate in 8.5%. During two procedures (0.5%), the AE was considered severe and therefore the procedure was interrupted. If those with AEs due to lower calcium were removed from analyses, 6.4% had AEs. Significantly more AEs were found when plasma was used as a replacement fluid (p=0.017, RR 2.05, CI 1.17-3.60). There were no differences in the incidence of AEs between genders. The number of procedures was too small to allow sub analyses of AEs in relation to the diagnoses. Adverse events were not related to the procedure used (p=0.095). Those who received additional Ca infusion during the procedure had no AEs (40 sessions) while the others who received no prophylactic Ca had an AE on 45 occasions (p=0.0141, RR 1.116, CI 1.08-1.15). CONCLUSION Data from the registry shows that centers have various approaches to apheresis. One can learn from each other's experience to reduce side effects and improve efficacy. From these data we noted that prophylactic Ca infusion reduced side effects.
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Affiliation(s)
- Bernd Stegmayr
- University Hospital, Division of Nephrology, Department of Internal Medicine, University Hospital of Northern Sweden, SE 901 85 Umeå, Sweden.
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Stegmayr B, Klingstedt J, Grahn BE, Vinnervik P. The new WAA apheresis registry. Transfus Apher Sci 2006; 34:259-62. [PMID: 16839818 DOI: 10.1016/j.transci.2005.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 12/15/2005] [Indexed: 10/24/2022]
Abstract
The WAA (World Apheresis Association) registry for apheresis has been developed to enable registration through internet by centers all around the world. It is of no charge for the registering centers. The new version is available at the site www.iml.umu.se/medicin. Until now more than 5700 treatments have been registered from centers in 6 countries. It allows registration of acute or chronic therapeutic apheresis and also collection of stem cells, cellapheresis, photopheresis and various adsorption technologies. Registration includes diagnoses, access, anticoagulation, replacement fluids, mode of treatment, volumes processed, techniques used and adverse events that develop. Analyses of data enables improvement of quality of apheresis. The new registry enables you to change data that were wrongly entered as well as add data that was missed when you firstly entered the file. We cordially invite all of you to join the registration procedure.
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Affiliation(s)
- Bernd Stegmayr
- Division of Nephrology, Department of Internal Medicine, University Hospital of Northern Sweden and Institute for Interactive Learning and Education, Umea University, SE 901 85 Umea, Sweden.
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Abstract
This article summarizes the current evolutions regarding artificial organs in Europe. The review emanates from the activities by four of the work groups of the European Society for Artificial Organs (ESAO) and is essentially based on the reports by these work groups at the latest ESAO meeting in Warsaw, Poland (2004). The topics are: apheresis, heart support, liver support, uremic toxins.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital, Gent, Belgium.
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Stegmayr BG. A survey of blood purification techniques. Transfus Apher Sci 2005; 32:209-20. [PMID: 15784456 DOI: 10.1016/j.transci.2004.10.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 11/16/2022]
Abstract
Apheresis may be performed with many different techniques. The basis for different therapeutic approaches lies in the pathophysiological processes present in the diseases that have to be treated. Over the years more sophisticated devices have been developed. The most frequent treatment is plasma exchange (plasmapheresis) using centrifugation or single filtration techniques. In addition cascade filtration and subsequent adsorption from plasma is done. Thereby removal is done by adsorption of molecules such as bilirubin, immunoglobulins (immunoadsorption), circulating immune complexes, various antibodies including those against blood types. Such adsorption technologies have also been developed to allow adsorption directly from a column perfused by whole blood (hemoperfusion). By combining various techniques, systems are available that allow bridging of patients with hepatic failure to transplantation (MARS, Prometheus). By adding e.g., hepatic cells to such systems, besides dialysis and adsorption, cells will help to degrade toxic molecules. Such bioreactors are in clinical use. Apheresis includes also the removal or retrieval of cells from blood for e.g., stemcell transplantation, polycythaemia or hemochromatosis. Removal of leukocytes from blood using leukocyte filters is indicated in inflammatory bowel diseases. By specifically irradiating lymphocytes and monocytes with UV light using the technique of extra corporeal photochemotherapy (ECTP) various immunological diseases are treated. On the other hand, various alternative techniques may be used for the same disorder. Thus for patients with high plasma LDL-cholesterol not responding to other lipid lowering strategic treatment, alternative therapy may be done either by cascade filtration, adsorption technology from plasma, heparin precipitation (HELP-system) or hemoperfusion. This article describes various techniques in clinical use.
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Affiliation(s)
- Bernd G Stegmayr
- Medicinkliniken, Norrlands Universitetssjukhus, 901 85 Umea, Sweden.
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Stegmayr BG, Ivanovich P, Korach JM, Rock G, Norda R, Ramlow W. World apheresis association—world apheresis registry. Transfus Apher Sci 2005; 32:205-7. [PMID: 15784455 DOI: 10.1016/j.transci.2004.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/01/2004] [Indexed: 11/17/2022]
Abstract
In 2002 WAA decided to start a world-wide apheresis registry to gain insight into the extent of treatment, adverse events, and to facilitate contacts among centers when treatment indications are rare and experience limited. Stem cell and other blood products collections intended for therapeutic application can also be entered. The WAA planned to use the French Registry. Its translation into English has not been accomplished and the fiscal obligations for that registry has not, as yet, been determined or considered and approved by the WAA Board. From Dec 2002 the proposed registry (a merged version of the French, Canadian and Swedish registries) can be immediately implemented. We now cordially invite all centers to join that registry. Please, also inform colleagues at other centers in your country to join. E-mail and address lists of colleagues in your country who have not registered will be welcomed. The site is at: Go to World Apheresis Registry; Login code to test the Registry is: al61tms. Then apply for a specific login code for your center. We welcome you to this registry for your input of data. You will not be charged any registration fee. The registry includes a randomization system that can be used for local or multi center studies (randomization by in-center basis allows you to make your own studies). It includes a formula that increases the chance to get a more even distribution between groups also for smaller sample sizes.
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Affiliation(s)
- B G Stegmayr
- Medicinkliniken Norrlands Universitetssjukhus, 901 85 Umea, Sweden.
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Purpura thrombotique thrombocytopénique et autres syndromes de microangiopathie thrombotique. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.emch.2004.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stegmayr BG, Ivanovich P, Korach JM, Rock G, Norda R, Ramlow W. World apheresis registry. J Clin Apher 2005; 20:126-7. [PMID: 15880360 DOI: 10.1002/jca.20044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- B G Stegmayr
- Medicinkliniken, Norrlands Universitetssjukhus, 901 85 Umea, Sweden
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Carandina-Maffeis R, Nucci A, Marques JFC, Roveri EG, Pfeilsticker BHM, Garibaldi SG, de Deus-Silva L. Plasmapheresis in the treatment of myasthenia gravis: retrospective study of 26 patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2004; 62:391-5. [PMID: 15273832 DOI: 10.1590/s0004-282x2004000300003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analyzed the experience of Unicamp Clinical Hospital with plasma exchange (PE) therapy in myasthenia gravis (MG). About 17.8 % of a totality of MG patients had PE performed: 26 cases, 19 women and seven men. The mean age-onset of MG was 28 years, extremes 11 and 69. Minimum deficit observed in the group was graded IIb (O & G) or IIIa (MGFA scale). One patient had prethymectomy PE. In seven the procedures were performed due to myasthenic crisis and in 18 patients due to severe myasthenic symptoms or exacerbation of previous motor deficit. Two patients were also submitted to chronic PE considering refractoriness to other treatments. Twenty-six patients had 44 cycles of PE and 171 sessions. The mean number of sessions was 3.9 (SD ± 1.4) each cycle; median 5, extremes 2 and 6. The mean time by session was 106,5 minutes (SD ± 35.2); median 100.5 (extremes of 55 and 215). The mean volume of plasma exchanged in each session was 2396 ml (SD ± 561); median 2225 (extremes 1512 and 4500). Side effects occurred: reversible hypotension (seven cases), mild tremor or paresthesias (seven cases). Infection and mortality rates due to PE were zero. All patients had immediate benefit of each PE cycle and usually they also received prednisone or other immunosuppressors. Good acceptance of the procedure was observed in 80.7% of patients.
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