Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures.
The type and number of complications was prospectively examined in 1,727 successive TPE treatments in 174 patients over 66 months at a single center. Most treatments were prescribed for thrombotic thrombocytopenic purpura (TTP; 42%), recurrent focal segmental glomerulosclerosis (FSGS; 22%), or myasthenia gravis (MG; 13%). About 57% of treatments used albumin-saline as the replacement solution and 43% used fresh-frozen plasma (FFP), almost all for TTP. There were 889 complications; 614 treatments (36% of the total) involved a complication. Most complications were minor; there were no deaths. Three treatments (0.2%) were discontinued due to a complication, and 2 (0.1%) required transfer to a higher acuity hospital bed. The most common complications were fever (7.7% of treatments), urticaria (7.4%), and hypocalcemic symptoms (7.3%). 42% of treatments with FFP involved a complication, compared to 30% of treatments using albumin-saline (P < 0.0001). The most common complications with FFP were urticaria (17%) and pruritus (13%); these occurred more commonly than in patients receiving albumin-saline. The most common complications with albumin-saline replacement were hypocalcemic symptoms (8.2%) and mild hypotension (8.1%). Mild and severe hypotension was significantly (P < 0.0001) more common with albumin-saline replacement. TPE is associated with a number of minor complications. Complications occur more commonly with FFP replacement compared to albumin-saline replacement. Pruritus and urticaria occur more commonly with FFP, and hypotension occurs more commonly with albumin-saline.
Shemin
Douglas
D
Division of Renal Diseases, Rhode Island Hospital, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island 02903, USA. Dshemin@lifespan.org
Briggs
Doris
D
Greenan
Melanie
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000627:therapeutic use*; D002648:Child; D005923:Glomerulosclerosis, Focal Segmental / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000628:therapy; D010949:Plasma; D010951:Plasma Exchange / Q000009:adverse effects*; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy; D016896:Treatment Outcome
D000418:Albumins