Therapeutic plasma exchange: complications and management

Area of Science:

• Nephrology
• Hematology
• Critical Care Medicine

Background:

• Therapeutic plasma exchange (TPE) is utilized across various conditions, including those with renal involvement like Goodpasture's syndrome, multiple myeloma, cryoglobulinemia, and thrombotic thrombocytopenic purpura.
• Assessing the safety profile of TPE is crucial for its clinical application in complex disease states.

Purpose of the Study:

• To evaluate the safety and adverse event profile of therapeutic plasma exchange (TPE).
• To identify factors influencing the incidence of adverse reactions during TPE procedures.

Main Methods:

• A retrospective review of 699 TPE treatments performed at the University of Connecticut from January 1988 to June 1991.
• Analysis of adverse reaction types, frequencies, and correlation with specific interventions like calcium and albumin administration.

Main Results:

• An overall adverse reaction incidence of 9.7% (68 of 699 treatments) was observed.
• Hypocalcemia, hypovolemia, and anaphylactoid reactions were the most frequent complications.
• Prophylactic calcium administration significantly reduced hypocalcemic symptoms (1% vs. 9.1%).
• Albumin as volume replacement was associated with fewer adverse reactions compared to fresh-frozen plasma (1.4% vs. 20%).
• Serious complications, including cardiovascular and respiratory events, were rare (0.2% each).

Conclusions:

• Therapeutic plasma exchange is a relatively safe procedure with a low incidence of serious complications.
• Prophylactic calcium administration is effective in mitigating hypocalcemic symptoms during TPE.
• Albumin is a preferred volume replacement agent over fresh-frozen plasma to minimize adverse events.