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Therapeutic plasma exchange in patients withneurologic diseases: Retrospective multicenterstudy

R.N. Makroo a,*, Aakanksha Bhatia b

aDirector Professor and Sr. Consultant, Department of Transfusion Medicine, Transplant Immunology & Molecular

Biology, Indraprastha Apollo Hospitals, New Delhi, IndiabRegistrar, Department of Transfusion Medicine, Transplant Immunology & Molecular Biology, Indraprastha Apollo

Hospitals, New Delhi, India

Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Leylagul Kaynar, Fevzi

Altuntas, Ismet Aydogdu, Burhan Turgut, Ismail Kocyigit, Sibel Kabukcu Hacıoglu, Sevda Ismailogulları, Nilda Turgut, M. Ali

Erkurt, Ismail Sari, Mehmet Oztekin, Musa Solmaz, Bulent Eser, Ali Ozdemir Ersoy, Ali Unal, Mustafa Cetin. Transfus Apher

Sci. April 2008;38(2):109e115.

Abstract

Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune aetiology was

known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university

hospitals.

The study was a retrospective review of the medical records of neurological patients (n ¼ 57) consecutively treated with

TPE between April 2006 and May 2007. TPE indications in neurological diseases included GuillaineBarre Syndrome (GBS)

(n ¼ 41), myasthenia gravis (MG) (n ¼ 11), acute disseminated encephalomyelitis (ADEM) (n ¼ 3), chronic inflammatory

demyelinating polyneuropathy (CIDP) (n ¼ 1) and multiple sclerosis (MS) (n ¼ 1). Patient median age was 49; there was a

predominance of males. Twenty-two patients had a history of other therapy including intravenous immunoglobulin (IVIG),

steroid, azathioprine, and pyridostigmine prior to TPE. Another 35 patients had not received any treatment prior to TPE. All

patients were classified according to the Hughes functional grading scores pre- and first day post-TPE for early clinical

evaluation of patients.

The TPE was carried out 1e1.5 times at the predicted plasma volume every other day. Two hundred and ninety-four

procedures were performed on 57 patients. The median number of TPE sessions per patient was five, and the median

processed plasma volume was 3075 mL for each cycle. Although the pre-TPE median Hughes score of all patients was 4, it

had decreased to grade 1 after TPE. While the pre-TPEmedian Hughes score for GBS and MG patients was 4, post-TPE scores

were decreased to grade 1. Additionally, there was a statistically significant difference between post-TPE Hughes score for

GBS patients with TPE as front line therapy and patients receiving IVIG as front line therapy (1 vs. 3.5; p ¼ 0.034). Although

there was no post-TPE improvement in Hughes scores in patients with ADEM and CIDP, patients with MS had an improved

Hughes score from 4 to 1. Mild and manageable complications such as hypotension and hypocalcemia were also observed.

TPE may be preferable for controlling symptoms of neuro-immunological disorders in early stage of the disease, espe-

cially with GBS.

* Corresponding author.E-mail address: makroo@apollohospitals.com (R.N. Makroo).

0976-0016/$ e see front matterhttp://dx.doi.org/10.1016/j.apme.2013.08.002

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Comments

Therapeutic plasma exchange has been accepted as an

important treatment modality in patients with various

neurological diseases. The authors have demonstrated with

success, a good response to 1e1.5 volumeplasmaexchanges in

most of their cases especially in patients of Myasthenia Gravis

and GuillaineBarre Syndromes. Favourable response was also

observed in patients with Multiple Sclerosis. They have also

demonstrated that the procedure is not only effective but also

safe, with only minimal adverse reactions in few patients,

which were not severe enough to interrupt the procedures.

The Indraprastha Apollo Hospitals, being an advanced

tertiary care and referral centre caters to a large number of

patients from all disciplines of medicine. With a busy plasma

exchange programme, we successfully treat patients with

renal, neurological and haematological disorders among

others. We have encountered 26 cases with neurological dis-

eases, which include 11 cases of Myasthenia Gravis and 9

cases of GBS among others in our experience so far. These

have been treated with 1e5 sittings of 1e1.5 volume ex-

changes each. Eighteen of them showed definite clinical

improvement, while 6 did not. Two patients were lost to

follow up.

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