January-March 2018

Role of Therapeutic Plasma Exchange in Neuro-immunological Disorder

Parul Prajapati1, Milind Dighe2, Farzana Kothari3

12rd Year Resident, 2HOD, 3Associate Professor in Immunoheamatology and Blood Transfusion, Baroda.


BACKGROUND AND OBJECTIVES: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used to remove high molecular weight substances from the plasma. TPE is a well-established therapeutic procedure used in many neuro-immunological disorders. The benefit of plasma exchange occurs by elimination of pathognomonic inflammatory mediators, including complement components, autoantibodies , cytokines and cholesterol containing lipoprotein and myeloma light chains. This study was carried out to determine the role of therapeutic plasma exchange in neurological disorder at SSG Hospital, vadodara. METHODS: It is prospective and retrospective study on the effect of TPE in neuro-immunological disorders. TPE are studied for a period from March 2015 to May 2017. The amount of plasma to be exchanged during TPE was determined using the formula EPV = (0.065 x wt [kg]) x (1-hematocrit). TPE was performed using a Fresenius cabi intermittent flow cell separator. RESULTS: A total of 122 TPE procedures were performed on 27 patients. In which the improvement begins within days of commencing the treatments and progressed steadily so that 23 out of 27 patients who responded to TPE with a manageable adverse reaction. Only 4 patients failed to respond this therapy. So the clinical outcome for therapeutic plasma exchange for Neuro-immunological cases were 85.18% and remaining 14.62% doesn’t show any improvement after five plasma exchanges. CONCLUSION: TPE is a first line of management for most of the neuro-immunological disorder. In our study there was an improvement in motor performance after 3-5 plasma exchanges which are due to removal of unbound antibodies from the plasma. The result suggests that 3-5 procedures on alternative days with 1-1.5 volume of plasma exchange gives a better result in patient with neuro-immunological diseases.

Keywords: Myasthenia Gravis, Guillain-Barré Syndrome, extracorporeal

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