title: Therapeutic plasma exchange in the treatment of myasthenia gravis.
abstract: OBJECTIVE
  The aim of this study was to analyze the retrospective experience related to the indication, complication and outcome of Therapeutic Plasma Exchange (TPE) in Myasthenia gravis (MG). It is a well known autoimmune disease characterized by antibodies against the acetylcholine receptor (anti-ACHR) on the post synaptic surface of the motor end plate. Plasma exchange is the therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence.
  
  
  METHODS
  A total of 35 patients of MG were submitted to a total of 41 cycles and 171 session of TPE. It was performed using a single volume plasma exchange with intermittent cell separator (Hemonetics) by Femoral or central line access and schedule preferably on alternate day interval. Immediate outcome was assessed shortly after each session and overall outcome at discharge.
  
  
  RESULTS
  Total of 110 patients of MG who were admitted to our hospital during the study period of two years. 35 (31.8%) patients had TPE performed with mean age of 32 years (M:F = 2:1). The mean number of TPE session was 4.2 (SD±1.2), volume exchange was 2215 ml (SD±435); overall incidence of adverse reaction was 21.7%. All patients had immediate benefits of each TPE cycle. Good acceptance of procedure was observed in 78.3% of patients.
  
  
  CONCLUSIONS
  TPE may be considered as one of the treatment options especially in developing countries like ours as it is relatively less costly but as effective for myasthenic crisis as other modalities.
authors.affiliation: Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: S Paul
authors.initials: SP
authors.lastname: Birinder
authors.affiliation: Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sonia
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Amarjit
authors.initials: A
authors.lastname: Kaur
keywords: Adverse reaction; auto antibodies; myasthenia gravis; therapeutic plasma exchange