Therapeutic plasma exchange in Mexico: experience from a single institution

Information about therapeutic plasma exchange (TPE) in developing countries is lacking. We report our experience with TPE performed for different indications during a 7-year period. We reviewed all TPE procedures performed in our institution during a 7-year period. Patients were divided in four groups according to the following indications: thrombotic microangiopathies (TM), myasthenia gravis (MG), polyneuropathies (PNP), and miscellaneous indications (MI). Clinical outcome (CO) and complications were evaluated. Eighty-seven procedures were carried out in 81 patients, for a total of 376 TPE sessions. Eighty-two procedures were analyzed for CO. In the group of TM we had 65% overall response rate (ORR): 35% complete response (CR) and 30% partial response (PR). Six (28.6%) patients died in this group. In the MG group we had 90% ORR: 69% CR and 21% PR. In the PNP group we had 78% ORR: 56% CR and 22% PR. In the MI group we had 92% ORR: 59% CR and 33% PR. We observed 47 adverse reactions in 40 (46%) procedures performed in 38 (47%) patients. This represented 12.5% of sessions. We had seven major complications leading to TPE discontinuation; this represented 8% of the procedures and 1.8% of sessions. One patient (0.2%) died during TPE. Our overall results are acceptable. In the TM group our results are somewhat lower than in other published reports, but in MG and PNP our results are similar to other published reports. Our complication rate is similar to that reported by others. Careful selection of patients and protocols is crucial to achieve maximum benefit from TPE programs in countries where plasmapheresis facilities are not widely available.