New directions in plasma exchange.
OBJECTIVE
This review examines the literature published on therapeutic plasma exchange during 2002. The review was performed by searching Medline for pertinent articles.


RESULTS
One hundred thirty articles were identified, of which 11 are reviewed. During the period, reviews of the use of therapeutic plasma exchange for managing Guillain-Barré syndrome and myasthenia gravis were published. A large randomized trial of the use of plasma exchange to treat sepsis also appeared. Finally, a large case series of the use of plasma exchange in Wegener granulomatosis was published.


CONCLUSIONS
The literature confirms the use of plasma exchange for Guillain-Barré syndrome but suggests that inadequate evidence exists to support its use for long-term improvement in myasthenia gravis. The study of patients with severe sepsis suggests that plasma exchange may benefit a subset of patients, those with abdominal infections. Finally, plasma exchange for Wegener granulomatosis with severe renal dysfunction appears not to offer any benefit over immunosuppressive therapy.
Winters
J L
JL
Laboratory Medicine and Pathology, Mayo Medical School and Division of Tranfusion Medicine, Mayo Clinic and Mayo foundation, Rochester, Minnesota 55905, USA.
Pineda
A A
AA
D014890:Granulomatosis with Polyangiitis / Q000628:therapy; D020275:Guillain-Barre Syndrome / Q000628:therapy; D006801:Humans; D009157:Myasthenia Gravis / Q000628:therapy; D010951:Plasma Exchange / Q000639:trends*; D018805:Sepsis / Q000628:therapy; D016896:Treatment Outcome