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Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases.


Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n = 22), myasthenia gravis (n = 21), chronic inflammatory demyelinating polyneuropathy (n = 7), polymyositis (n = 3), multifocal motor neuropathy (n = 2), acute disseminated encephalomyelitis (n = 2), neuromyelitis optica (n = 2), multiple sclerosis (n = 2), limbic encephalitis (n = 1) and transverse myelitis (n = 1). TPE was frontline therapy in 57 % of the patients (n = 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

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elvey says:

It occurs to me that, in a sense, *most* plasmapheresis *IS* IVIG. So, for example, in one course of treatment, I received 96 units of plasma, in other words, plasma of 96 people in one hospitalization, and IG is in plasma, IIRC. That’s not the IG from thousands of people in IVIG, but it’s still quite something.
Makes me wonder if there are any stats on the effectiveness of plasmapheresis with manufactured plasma I mentioned in my comment above, either in NMO or in related illnesses also sometimes treated with IVIG. Anyone?

elvey says:

I also wonder how the three compare when it comes to total price of a PLEX treatment course of each. Anyone have any price data?

elvey says:

Interesting news regarding HES. I had read about OsrHSA in “Large-scale production of functional human serum albumin from transgenic rice seeds” when I was getting TPE / PLEX for my NMO and received contradictory information from my caregivers about whether the plasma replacement I was getting was from donated human blood or not. Wonder which of the three they’ll give me next time I need TPE.

Much appreciation to the foundation for this, Spectrum, and all they do!

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