Complications of plasma exchange in neurological patients

Complications occurred during 154 plasma exchanges performed in 17 patients for a variety of neurological disorders. Mild, self-limited, toxic reaction to citrate was the most frequent complication (7.8%), followed by transient hypotension (2.6%) and visual scotomata (1.3%). More serious complications, occurring on one occasion each, were cardiac arrhythmia, myocardial infarction, and gross hemolysis. There were no infections. The spectrum and frequency of complications in these plasma exchanges were compared with those in other series dealing with both neurological and nonneurological patients. Several risk factors for development of complications were identified, one of the most important being the nature of the illness being treated. The incidence of two of the most serious complications, severe infection and bleeding diathesis, appeared to be higher in patients with renal insufficiency or hematologic disorders, respectively, than in neurological patients.