title: Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases.
abstract: Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48 years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n= 22), myasthenia gravis (n= 21), chronic inflammatory demyelinating polyneuropathy (n= 7), polymyositis (n= 3), multifocal motor neuropathy (n= 2), acute disseminated encephalomyelitis (n= 2), neuromyelitis optica (n= 2), multiple sclerosis (n= 2), limbic encephalitis (n= 1) and transverse myelitis (n= 1). TPE was frontline therapy in 57 % of the patients (n= 36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97 % and through a peripheral venous access in 3 % of the patients. Human albumin was used as replacement fluid in 49 %, hydroxyethyl starch (HES) in 49 % and fresh frozen plasma in 2 % of the cases. Adverse reactions were recorded in 60 % of the patients. Total ratio of complications in 517 TPE procedures was 10.8 % and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81 %. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.
authors.affiliation: Department of Hematology, Mersin University Faculty of Medicine, Çiftlikköy Kampüsü, Mersin, Turkey.
authors.forename: Anil
authors.identifier: 0000-0002-7195-1845
authors.initials: A
authors.lastname: Tombak
authors.affiliation: Department of Hematology, Mersin University Faculty of Medicine, Çiftlikköy Kampüsü, Mersin, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Uçar
authors.affiliation: Department of Hematology, Mersin University Faculty of Medicine, Çiftlikköy Kampüsü, Mersin, Turkey.
authors.forename: Aydan
authors.initials: A
authors.lastname: Akdeniz
authors.affiliation: Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey.
authors.forename: Arda
authors.initials: A
authors.lastname: Yilmaz
authors.affiliation: Department of Neurology, Mersin University Faculty of Medicine, Mersin, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Kaleagası
authors.affiliation: Department of Biostatistics, Duzce University, Düzce, Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Sungur
authors.affiliation: Department of Hematology, Mersin University Faculty of Medicine, Çiftlikköy Kampüsü, Mersin, Turkey.
authors.forename: Eyup Naci
authors.initials: EN
authors.lastname: Tiftik
keywords: Demyelinating disease; Guillain-Barrè syndrome; Myasthenia gravis; Polyneuropathy; Therapeutic plasma exchange