Tolerance and complications of therapeutic plasma exchange by centrifugation: A single center experience

Valentin Coirier, Mathieu Lesouhaitier, Florian Reizine, Benoît Painvin, Quentin Quelven, Adel Maamar, Arnaud Gacouin, Jean-Marc Tadié, Yves Le Tulzo, Christophe Camus, Valentin Coirier, Mathieu Lesouhaitier, Florian Reizine, Benoît Painvin, Quentin Quelven, Adel Maamar, Arnaud Gacouin, Jean-Marc Tadié, Yves Le Tulzo, Christophe Camus

Abstract

Introduction: Therapeutic plasma exchange (TPE) constitutes an important therapy for hematological, neurological, immunological, and nephrological diseases. Most studies have focused on efficacy, whereas tolerance and complications during sessions have been less well studied and not recently.

Material and methods: We conducted a single center retrospective study of all patients who underwent TPE between 2011 and 2018. TPE sessions using the centrifugation technique were performed by dedicated trained nurses. Specific side effects were identified through surveillance forms completed contemporaneously. The primary outcome was the rate of all-type adverse effects that occurred during the TPE sessions.

Results: In total, 1895 TPE sessions performed on 185 patients were analyzed. At least one adverse effect was reported for 805 sessions (42.5% [29.9%-70.1%]), corresponding to 171 patients (92.4% [87.6%-95.8%]). Hypotension occurred during 288 sessions (15.2%), was asymptomatic in 95.8% of cases, and more frequent with the use of 4% albumin than fresh frozen plasma (FFP) (19.8 vs 8.9%, P <.0001). Hypocalcemia occurred during 370 sessions (19.6%) and was more frequent with the use of FFP than with the use of albumin alone (FFP alone: 28.0%, albumin + FFP: 26%, albumin alone: 11.7%; P <.0001). Allergic reactions occurred during 56 sessions (3%), exclusively with FFP. Severe adverse effects were reported for 0.3% of sessions and 5.4% of patients.

Conclusions: TPE is a safe therapy when performed by a trained team. Adverse effects were frequent but mostly not serious. The replacement fluid was the main determinant of the occurrence of complications. (ClinicalTrials.gov ID: NCT03888417).

Keywords: albumin; allergic reaction; fresh frozen plasma; hypocalcemia; hypotension; therapeutic plasma exchange.

© 2021 Wiley Periodicals LLC.

References

REFERENCES

    1. Schwab PJ, Fahey JL. Treatment of Waldenström's Macroglobulinemia by plasmapheresis. N Engl J Med. 1960;263:574-579.
    1. van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré Syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992;326:1123-1129.
    1. Jayne D, Gaskin G, Rasmussen N, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol. 2007;18:2180-2188.
    1. Rock GA, Shumak KH, Buskard NA, et al. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. N Engl J Med. 1991;325:393-397.
    1. Larsen FS, Schmidt LE, Bernsmeier C, et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol. 2016;64:69-78.
    1. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing Committee of the American Society for apheresis: the eight special issue. J Clin Apher. 2019;34:171-354.
    1. Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol. 2014;164:342-351.
    1. Kaplan AA. Moderator's view: high-volume plasma exchange: pro, con and consensus. Nephrol Dial Transplant. 2017;32:1464-1467.
    1. George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med. 2014;371:654-666.
    1. Madore F. Plasmapheresis. Technical aspects and indications. Crit Care Clin. 2002;18:375-392.
    1. Norda R, Stegmayr BG. Therapeutic apheresis in Sweden: update of epidemiology and adverse events. Transfus Apher Sci. 2003;29:159-166.
    1. Korach JM, Petitpas D, Paris B, et al. Plasma exchange in France: epidemiology 2001. Transfus Apher Sci. 2003;29:153-157.
    1. Rock G, Clark B, Sutton D. The Canadian apheresis registry. Transfus Apher Sci. 2003;29:167-177.
    1. Korach JM, Loron G, Fadel F, et al. Adult and paediatric therapeutic hemapheresis. Réanimation. 2005;14:641-650.
    1. Agreda-Vásquez GP, Espinosa-Poblano I, Sánchez-Guerrero SA, et al. Starch and albumin mixture as replacement fluid in therapeutic plasma exchange is safe and effective. J Clin Apher. 2008;23:163-167.
    1. Hafer C, Golla P, Gericke M, et al. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. Int Urol Nephrol. 2016;4:133-138.
    1. Lee G, Arepally GM. Anticoagulation techniques in apheresis: from heparin to citrate and beyond. J Clin Apher. 2012;27:117-125.
    1. Ring J, Laubenthal H, Messmer K. Incidence and classification of adverse reactions to plasma substitutes. Klin Wochenschr. 1982;60:997-1002.
    1. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1-45.
    1. Bramlage CP, Schröder K, Bramlage P, et al. Predictors of complications in therapeutic plasma exchange. J Clin Apher. 2009;24:225-231.
    1. Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Ther Apher Dial. 2005;9:391-395.
    1. Couriel D, Weinstein R. Complications of therapeutic plasma exchange: a recent assessment. J Clin Apher. 1994;9:1-5.
    1. Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher. 2007;22:270-276.
    1. Reutter JC, Sanders KF, Brecher ME, Jones HG, Bandarenko N. Incidence of allergic reactions with fresh frozen plasma or cryo-supernatant plasma in the treatment of thrombotic thrombocytopenic purpura. J Clin Apher. 2001;16:134-138.
    1. Yeh JH, Chiu HC. Plasmapheresis-related hypotension. Artif Organs. 2000;24:705-709.
    1. Shafi T, Mullangi S, Jaar BG, Silber H. Autonomic dysfunction as a mechanism of intradialytic blood pressure instability. Semin Dial. 2017;30:537-544.
    1. Stamboulis E, Katsaros K, Koutsis G, Iakovidou H, Giannakopoulou A, Simintzi I. Clinical and subclinical autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve. 2006;33:78-84.
    1. Figueroa JJ, Dyck P, Laughlin RS, et al. Autonomic dysfunction in chronic inflammatory demyelinating polyradiculoneuropathy. Neurology. 2012;78:702-708.
    1. Guidet B, Staikowsky F, Vassal T, Offenstadt G, Amstutz P. Efficacy and tolerance of Elohes in plasma exchanges. Ann Fr Anesth Reanim. 1992;11:534-539.
    1. Varrier M, Ostermann M. Fluid composition and clinical effects. Crit Care Clin. 2015;31:823-837.
    1. Laxenaire MC, Charpentier C, Feldman L. Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study. Ann Fr Anesth Reanim. 1994;13:301-310.
    1. Brecher ME, Owen HG. Washout kinetics of colloidal starch as a partial or full replacement for plasma exchange. J Clin Apher. 1996;11:123-126.
    1. Garraud O, Coppo P. Types of fresh plasma with focus on therapeutic plasma exchange. Transfus Apher Sci. 2018;58:258-261.
    1. Saadah NH, van der Bom JG, Wiersum-Osselton JC, et al. Comparing transfusion reaction risks for various plasma products-an analysis of 7 years of ISTARE haemovigilance data. Br J Haematol. 2018;180:727-734.
    1. Stegmayr B, Ptak J, Wikström B. World apheresis registry report. Transfus Apher Sci. 2007;36:13-16.
    1. Cid J, Carbassé G, Andreu B, Baltanás A, Garcia-Carulla A, Lozano M. Efficacy and safety of plasma exchange: an 11-year single-center experience of 2730 procedures in 317 patients. Transfus Apher Sci. 2014;51:209-214.

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