Therapeutic plasma exchange in the elderly: experience at a tertiary center

Therapeutic plasma exchange (TPE) is a beneficial albeit complicated method of therapy. The elderly, persons 65 years or older are growing in number, with increasing need for different therapeutic interventions including TPE. The elderly are more likely to have complications and pose challenges when considering TPE--both in terms of indications and outcomes. We retrospectively investigated the utility of TPE in terms of indications and mortality in the elderly (65 and above) versus a younger cohort (18-64 years) between January 1, 2000 and June 30, 2010. During this period, 581 patients required 4,722 TPE treatment sessions. Of them, 185 were elderly (31.8%) requiring 1,289 TPE sessions. The indications for TPE were neurological 14.1%, hematological 10.5%, renal 6.9%, and miscellaneous 2.0% in the elderly versus 22.7%, 20.8%, 20.7%, and 4.0% in the younger population undergoing TPE for neurological, hematological, renal and miscellaneous indications, respectively. We further investigated the mortality within 30 days of admission and a year later. The mortality figures within 30 days of admission and a year later in the elderly were 16.2% and 33.5%, respectively; higher than in the younger patients; 10.3% and 17.2%, respectively. We conclude that TPE is not an uncommon procedure in elderly, with more neurological indications, and is associated with higher mortality than younger patients.