Therapeutic Plasma Exchange Indications, Complications and Responses in Internal Medicine Patients: A Single Center, Retrospective Analysis

Year 2020, Volume: 42 Issue: 1, 14 - 26, 01.01.2020

Buğra Özkan Hava Üsküdar Teke Döndü Üsküdar Cansu Garip Şahin

https://doi.org/10.20515/otd.462835

Abstract

Therapeutic plasma exchange
(TPE) is a process that allows high molecular weight substances to be removed
from plasma. Therapeutic plasma exchange is widely used in many diseases in the
practice of internal medicine. Current guidelines on this process have been
published in recent years due to increased awareness and accessibility. The
most common and most comprehensive of these is the American Apheresis Society
(ASFA) guideline. In this study, we retrospectively determined the demographic
data, underlying diseases, biochemical parameters, volume and type of
replacement fluid, complications developed during and after the procedure,
additional treatments, need for dialysis, and the number of sessions for
patients who underwent therapeutic plasma exchange for any reason in the
internal medicine clinic aimed to reveal aspects that can be improved in
clinical practice. In the study, 117 patients between 2007 and 2016 were
evaluated retrospectively. Of all cases, 63 (53.8%) were female. At the time of
diagnosis, the mean age of the patients was 52.15 ± 16.8 (20-88) years. The
most common indications for TPE were thrombotic thrombocytopenic purpura (TTP)
and ANCA-associated vasculitis. Fresh frozen plasma and albumin were the most
commonly used replacement fluids. Catheter related complication rate was 5.1%.
The rate of complication related to TPE during TPE was 19.6%. No fatal
reactions to TPE treatment were observed. There was a significant relationship
between alkaline phosphatase (ALP) and mortality when the relationship between
the laboratory data and the mortality rate of the patients with TTP was
considered (p = 0.002). There was a significant correlation between chlorine
and hematocrit and mortality in ANCA-associated vasculitis patients (p = 0.029
and p= 0.037, respectively). For the purpose of estimating mortality, further
work is needed to confirm the validity of these laboratory data. As a result;
TPE is a useful, easy and effective life saving treatment with few side
effects.

Keywords

therapeutic plasma exchange, ttp, anca-associated vasculitis

Terapötik Plazma Değişimi Endikasyonları, Komplikasyonları ve Yanıtları; Tek Merkez, Retrospektif Analiz Sonuçları

Abstract

Terapötik plazma değişimi (TPD)
plazmadan yüksek molekül ağırlıklı maddelerin uzaklaştırılmasını sağlayan bir
işlemdir. Terapötik plazma değişimi işlemi iç hastalıkları pratiğinde birçok
hastalıkta yaygın olarak kullanılmaktadır. Bu işlem ile ilgili son yıllarda
farkındalığın ve ulaşılabilirliğin artmasına bağlı olarak güncel kılavuzlar
yayımlanmaktadır. Bunlardan en genel geçer ve kapsamlı olanı Amerikan Aferez
Cemiyeti (ASFA)’nin yayımladığı kılavuzdur. Bu çalışmada, iç hastalıkları
kliniğinde herhangi bir nedenle terapötik plazma değişimi yapılan hastaların
demografik verilerini, altta yatan hastalıklarını, biyokimyasal
parametrelerini, replasman sıvısının volümü ve tipini, işlem sırasında ve
sonrasında gelişen komplikasyonları, ek tedavileri, diyaliz ihtiyacı olup
olmadığını, seans sayılarını retrospektif olarak belirleyerek klinik pratikte
geliştirilebilecek yönleri ortaya koyabilmek amaçlandı. Çalışmada 2007 ve 2016
yılları arasındaki, 117 hasta retrospektif olarak değerlendirildi. Tüm
olguların 63 (%53,8)’ü kadın, 54 (%46,2)’ü erkekti. Tanı anında hastaların yaş
ortalaması 52,15 ± 16,8 (20-88) yıl idi. En sık TPD endikasyonu TTP ve ANCA
ilişkili vaskülit idi. Taze donmuş plazma ve albümin en sık kullanılan
replasman sıvılarıydı. Katater ilişkili komplikasyon oranı %5,1 idi. TPD
süresince TPD ilişkili komplikasyon oranı %19,6 idi. TPD işlemi ile ilgili
herhangi bir fatal reaksiyona rastlanılmadı. TTP tanılı hastaların başvuru
anındaki laboratuvar verileri ile mortalite arasındaki ilişkiye bakıldığında ALP
ve mortalite arasında anlamlı bir ilişki bulundu (p= 0.002). ANCA ilişkili
vaskülit hastalarında ise klor ve hematokrit ile mortalite arasında anlamlı bir
ilişki bulundu (sırasıyla p = 0.029, p= 0.037). Mortaliteyi tahmin etmede
kullanım amacıyla, bu laboratuvar verilerinin teyidi için ileri çalışmalara
ihtiyaç vardır. Sonuç olarak; TPD, çok az yan etki ile faydalı, kolay ve etkili
bir hayat kurtaran tedavi yöntemidir.

Keywords

terapötik plazma değişimi, ttp, anca ilişkili vaskülit

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