Prospective Evaluation of Critically İll Patients with Therapeutic Plasma Exchange in Medical İntensive Care Unit

Year 2023, , 79 - 83, 27.12.2023

Mustafa Çalışkan , Merve Aslan , Elif Nur Karaoğlu , Mihriban Yıldırım , Kürşat Gündoğan , Murat Sungur , Şahin Temel , Leylagül Kaynar

https://doi.org/10.55994/ejcc.1385367

Abstract

Aim: Therapeutic plasma exchange (TPD) is the separation of the patient's plasma for treatment purposes and the replacement of another fluid. Therapeutic plasma exchange, the use of which has expanded in recent years, is a treatment method that cleans the blood extra-corporeally and is used in many immunological and toxicological diseases. The aim of this study is to prospectively examine critical patients who are followed up in the intensive care unit and undergo therapeutic plasma exchange.

Material and Method: Patients who were hospitalized in the Intensive Care Unit of Erciyes University, Faculty of Medicine, older than 18, and whose therapeutic plasma exchange (TPD) indication were included in the study. Demographic information of the patients, indication for admission to intensive care unit, and TPD indication were recorded before the procedure. Patients who were indicated for plasmapheresis were observed for side effects during the procedure.

Results: A total of 31 patients were included in the study. The mean age of the patients was 46 ± 18 years. 52% of the patients were female and 48% were male. The hospitalization medyan APACHE II score (min-max: 5-40) of the patients was 20. When the patients were evaluated in terms of TPD indications in intensive care, the most common causes were 56% microangiopathic hemolytic anemia (MAHA), 13% Crimean Congo Hemorrhagic Fever (KKKA) and 10% Guillen Barre Syndrome.
The patients were divided into two groups: living and dying. When these two groups were analyzed in terms of APACHE II Score, the mean APACHE II score of living patients was 17±7, and the mean APACHE II score of the patients who died was 25 ± 9. This difference was statistically significant (p = 0.02). The median day of the patients staying in intensive care unit was 12 (min-max: 1-86), and intensive care mortality was 48%.

Conclusion: The frequency of TPD indications of patients included in the study is compatible with the literature, and TPD was applied most frequently because of MAHA. The patients were younger than the normal intensive care population. This study provides clinicians with some helpful information about the intensive care clinical course before patients undergo TPD.

Keywords

Therapeutic plasma exchange, intensive care unit, mortality, critical disease

Ethical Statement

Bu tez çalışması Erciyes Üniversitesi Tıp Fakültesi Etik Kurulu tarafından onaylandı (tarih:21.11.2018,karar no:2018/581 ve tarih:15.01.2020, karar no:2020/03). Katılımcılardan ve hasta yakınlarından kendi rızalarıyla çalışmaya katıldıklarını teyit eden imzalanmış bilgilendirilmiş gönüllü onam formları alındı

References

• 2014, 164(3):342-351.
• 2. Zarkovic M, Kwaan HC: Correction of hyperviscosity by apheresis. Semin Thromb Hemost 2003, 29(5):535-542.
• 3. Ward DM: Conventional apheresis therapies: a review. Journal of clinical apheresis 2011, 26(5):230-238.
• 4. Clark WF, Rock GA, Buskard N, et al: Therapeutic plasma exchange: an update from the Canadian Apheresis Group. Annals of internal medicine 1999, 131(6):453-462.
• 5. Levy JB, Turner AN, Rees AJ, Pusey CD: Long-term outcome of anti–glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression. Annals of internal medicine 2001, 134(11):1033-1042.
• 6. Ranganathan L, Menon R, Ramakrishnan N, Venkataraman R, Ramachandran P: Therapeutic Plasma Exchange Practices in Intensive Care Unit. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine 2019, 23(7):336.
• 7. Paton E, Baldwin IC: Plasma exchange in the intensive care unit: a 10 year retrospective audit. Australian Critical Care 2014, 27(3):139-144.
• 8. Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y 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 Eighth Special Issue. J Clin Apher 2019, 34(3):171-354.
• 9. Gundogan K, Coskun R, Guven M, Sungur M: Complications of endotracheal intubation in intensive care unit/Yogun bakimda endotrakeal entubasyon komplikasyonlari. Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi (Journal of Medical and Surgical Intensive Care Medicine) 2011:39-44.
• 10. Lemaire A, Parquet N, Galicier L, et al: Plasma exchange in the intensive care unit: technical aspects and complications. Journal of clinical apheresis 2017, 32(6):405-412.
• 11. Korach J-M, Petitpas D, Paris B, et al: Plasma exchange in France: epidemiology 2001. Transfusion and apheresis science 2003, 29(2):153-157.
• 12. Moake JL: Thrombotic microangiopathies. New England Journal of Medicine 2002, 347(8):589-600.
• 13. Drew M: Therapeutic plasma exchange in hematologic diseases and dysproteinemias. In: Apheresis: principles and practice. AABB Press, Bethasda, MD; 2003: 345-373.
• 14. George JN: How I treat patients with thrombotic thrombocytopenic purpura–hemolytic uremic syndrome. Blood, The Journal of the American Society of Hematology 2000, 96(4):1223-1229.
• 15. George JN: Clinical practice. Thrombotic thrombocytopenic purpura. The New England journal of medicine 2006, 354(18):1927-1935. 16. Gurkan E, Baslamisli F, Guvenc B, Kilic N, Unsal C, Karakoc E: Thrombotic thrombocytopenic purpura in southern Turkey: a single‐center experience of 29 cases. Clinical & Laboratory Haematology 2005, 27(2):121-125.
• 17. Altuntas F, Aydogdu I, Kabukcu S, et al: Therapeutic plasma exchange for the treatment of thrombotic thrombocytopenic purpura: a retrospective multicenter study. Transfusion and Apheresis Science 2007, 36(1):57-67.
• 18. Weber F, Mirazimi A: Interferon and cytokine responses to Crimean Congo hemorrhagic fever virus; an emerging and neglected viral zonoosis. Cytokine & growth factor reviews 2008, 19(5-6):395-404.
• 19. Kaynar L, Altuntas F, Aydogdu I, et al: Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Transfusion and Apheresis Science 2008, 38(2):109-115.
• 20. Busund R, Koukline V, Utrobin U, Nedashkovsky E: Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Intensive care medicine 2002, 28(10):1434-1439.
• 21. Pagnoux C: Plasma exchange for systemic lupus erythematosus. Transfusion and apheresis science 2007, 36(2):187-193.
• 22. Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Critical care medicine 1985, 13(10):818-829.
• 23. Moreno R, Morais P: Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study. Intensive care medicine 1997, 23(2):177-186.
• 24. Dada MA, Kaplan AA: Plasmapheresis treatment in Guillain–Barré syndrome: potential benefit over IVIg in patients with axonal involvement. Therapeutic Apheresis and Dialysis 2004, 8(5):409-412.