Outcomes of Therapeutic Plasma Exchange: Single Tertiary Center Experience in Bangladesh

Background: Therapeutic Plasma Exchange (TPE) is a well-established therapeutic procedure commonly used in many disorders of autoimmune etiology. It is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. Examples of these substances include immune complexes, pathogenic auto antibodies, endotoxin, cryoglobulins and cholesterol-containing lipoproteins and myeloma light chains. Early starting of Therapeutic plasma exchange after diagnosis of disease may enhance fast recovery. Aims/objectives: The aim of this study to assess the clinical outcome in patients of different immunological and non-immunological diseases treated with TPE. Methodology: This prospective study was done on patients referred to Transfusion Medicine Department, Asgar Ali Hospital, and Dhaka, Bangladesh for TPE during one year period (from January, 2018 to December, 2018). TPE procedures were performed on aphaeresis machine (Cobe Spectra, continuous flow cell separator). A minimum one and maximum of six procedures of plasma exchange were done depending upon the clinical outcome of the patient. 1-1.5 volume exchange was done per day or every alternate day. Demographics, clinical data, number of sessions, volume of plasma exchanged, patient’s tolerance and complications during or post to the procedure were systematically recorded. Results: A total sixty one (61) TPE procedures were done on fifteen (15) patients. Out of 13 patients, five patients had Guillain Barre Syndrome (GBS) followed by three patients with Thrombotic Thrombocytopenic Purpura (TTP) and others such as Good pusturs Syndrome, Renal allograft rejection, Wegener's granulomatosis, acute pancreatitis with hypertriglyceridemia, Dermatomyositis, hepatic failure and Hyper viscosity Syndrome were one each. Among fifteen patients, eleven patients (73.4%) were improved while four (26.6%) patients showed no improvement. Patients with GBS and TTP were fully improved. Patient had Acute Pancreatitis with Hypertriglyceridemia, Renal allograft rejection and hyper viscosity Syndrome was also improved. Total male was four (28.5%) and female was eleven (73.3%). Out of 61 procedures, two (3.2%) complications were reported and these were hypotension and mild citrate toxicity. Conclusion: Therapeutic plasma exchange is an effective adjuvant treatment for several diseases especially autoimmune and neurological diseases. TPE can reduce morbidity, mortality and improve patient’s outcome. So, it can be practice in all in practice tertiary care hospitals.