Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis · 2025
Safety profile of therapeutic plasma exchange in neurological diseases: Insights from a Polish intensive care unit.
СтатьяНазвание и аннотация: Перевод в очереди
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Czempik Piotr F, Osicki Jan, Dzięcioł Karina, Gołda Mikołaj
Аннотация
INTRODUCTION: While therapeutic plasma exchange (TPE) is generally considered safe, it carries potential risks. Close monitoring during and after the procedure is essential to identify and manage adverse events promptly. The benefits of TPE must be carefully weighed against these risks, particularly in patients with significant comorbidities. The study aimed to analyze the safety profile of TPE using membrane filtration (TPEm) performed for neurological disorders in patients admitted to the local intensive care unit (ICU).
MATERIAL AND METHODS: This was a retrospective, single-center study. All ICU patients receiving TPEm for neurological disorders in years 2019-2024 were analyzed. Retrieved data included demographics, disease severity scores, laboratory parameters, TPE indications, details regarding performance of TPEm, complications. Results were compared using standard parametric and non-parametric tests.
RESULTS: Twenty-five ICU patients underwent TPE for neurological diseases. Nineteen (76 %) patients presented with category I indications according to the American Society for Apheresis (ASFA). Human albumin was a sole replacement fluid. Systemic anticoagulation with unfractionated heparin was used in 21 (84 %) patients. In 16 (64 %) patients complications occurred, mainly hypotension (n = 8, 38.1 %) and thrombosis (n = 6, 28.6 %). No procedure-related mortality was reported. There was significant drop of hemoglobin, hematocrit, and platelets during treatment in the ICU.
CONCLUSIONS: Given the potential for procedural complications, most of them moderate, TPEm should be primarily reserved for ASFA category I and II neurological indications, in which its use is supported by evidence-based guidelines. In category III indications decision regarding TPE should be individualized if there are no other therapeutic alternatives.
MATERIAL AND METHODS: This was a retrospective, single-center study. All ICU patients receiving TPEm for neurological disorders in years 2019-2024 were analyzed. Retrieved data included demographics, disease severity scores, laboratory parameters, TPE indications, details regarding performance of TPEm, complications. Results were compared using standard parametric and non-parametric tests.
RESULTS: Twenty-five ICU patients underwent TPE for neurological diseases. Nineteen (76 %) patients presented with category I indications according to the American Society for Apheresis (ASFA). Human albumin was a sole replacement fluid. Systemic anticoagulation with unfractionated heparin was used in 21 (84 %) patients. In 16 (64 %) patients complications occurred, mainly hypotension (n = 8, 38.1 %) and thrombosis (n = 6, 28.6 %). No procedure-related mortality was reported. There was significant drop of hemoglobin, hematocrit, and platelets during treatment in the ICU.
CONCLUSIONS: Given the potential for procedural complications, most of them moderate, TPEm should be primarily reserved for ASFA category I and II neurological indications, in which its use is supported by evidence-based guidelines. In category III indications decision regarding TPE should be individualized if there are no other therapeutic alternatives.