Plasma-exchange program in a regional blood bank with a reference to Guillain-Barré syndrome

Plasma-exchange therapy for patients carried out over 5 years has been reviewed. In order to provide a comprehensive service by a regional blood bank serving 1.1 million population, an organization model has been presented. An example is illustrated with patients suffering from acute Guillain-Barré syndrome indicating that some 2-16% procedures might have to be performed in an intensive care area for minimizing serious potential complications in acutely ill patients. Using plasma as the exchanging fluid, complications (albeit minor, e.g. rigor and allergic reactions) have been compared and contrasted among various groups of patients. The quality and quantity of such reactions in two malignant melanoma patients appeared to be adrenergic and different than in patients with neurologic or nephrologic disorders. While definite indications for plasma-exchange are limited, their present increasing use might reflect a fashion and a parallel could be traced with the past. A plea has been made to be more critical about plasma-exchange in order to be caring and cost effective.