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Plasma exchange: the cost/benefit ratio and the critical revision of indications
M Valbonesi1, G Florio, G Lercari
1Immunohematology Division, San Martino Hospital, Genova, Italy.
Insights
Plasma-Exchange (PE) is increasingly beneficial for various conditions, including drug-induced hypertriglyceridemia and acute renal failure. This therapeutic modality offers a favorable cost-benefit ratio and is essential for hospitals.
Area of Science:
- Therapeutic Apheresis
- Nephrology
- Critical Care Medicine
Background:
- The applications of Plasma-Exchange (PE) are expanding to new clinical indications.
- Recent additions include Cyclosporin-A induced hypertriglyceridemia and myoglobinuric acute renal insufficiency.
Purpose of the Study:
- To review the evolving role and phases of Plasma-Exchange (PE) in clinical practice over the past 20 years.
- To assess the current necessity and cost-effectiveness of hemapheresis units in hospitals.
Main Methods:
- Retrospective review of clinical experiences with Plasma-Exchange (PE) over two decades.
- Analysis of the four evolutionary phases of therapeutic measures: discovery, confirmation, routine application, and decline.
Main Results:
- Plasma-Exchange (PE) has demonstrated efficacy in treating a growing number of conditions.
- A hemapheresis unit is considered essential for medium-sized hospitals, even for therapeutic procedures only.
- PE can significantly reduce hospital stays and is suitable for ambulatory patients, indicating a favorable cost-benefit ratio.
Conclusions:
- Plasma-Exchange (PE) remains a vital therapeutic option with expanding indications.
- Hemapheresis units are a necessary component of modern hospital infrastructure.
- The cost-effectiveness and efficiency of PE support its continued use in clinical practice.
Abstract:
The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency. Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years. Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.