Therapeutic Plasma Exchange (TPE)

1
Therapeutic plasma Exchange (TPE)
2
Therapeutic plasma Exchange

• A procedure in which blood of the patient is
  passed through a medical device which separates
  out plasma from other components of blood, the
  plasma is removed and replaced with a replacement
  solution such as colloid solution (e.g., albumin
  and/or plasma) or combination of
  crystalloid/colloid solution.
• Plasmapheresis Separation of plasma from whole
  blood using an automated cell separator and
  returning back the remaining components.

3
(No Transcript)
4
(No Transcript)
5
Categories for Therapeutic Apheresis Indications

• TA is standard and acceptable first line therapy,
  but not always mandatory.
• TA is generally accepted but considered to be
  supportive or adjunctive to other more definitive
  treatment or when first line measures fail or
  poorly tolerated.
• Existing evidence insufficient either to
  establish efficacy or TA or to clarify the risk
  benefit ratio associated with TA.
• Controlled Trials have not shown benefit or
  anecdotal reports are discouraging. TA is done
  only in the context of an IRB- approved research
  protocol.

Journal of Clinical Apheresis 22 95 (2007)
6
Colloid replacement fluids for TPE
Fluid Advantages Disadvantages
5 Albumin Viral safety Convenience Reactions rare High cost Most proteins not replaced
Fresh Frozen plasma (FFP)/ Single-donor plasma All proteins replaced Citrate reaction Urticaria Infection possible
7

• TPE removes the anti-ADAMTS 13 autoantiantibody
• Pre- and post-procedure hemogram, electrolytes
  (including ionized Ca) serum LDH and platelet
  count
• Daily TPE 1 to 1.5 times plasma volume was
  exchanged using group specific FFP.
• In view of anemia five units of PRBC were
  transfused during the procedures.
• 1 amp (10ml) of 10 calcium gluconate for every
  1000ml of plasma exchanged
• Received a total of 12 procedures
• No procedural complications except for two
  instances when patient developed mild allergic
  reaction
• Platelet count started to increase after 10th
  cycle of plasma exchange with peripheral smear
  showing less number of schistocytes.
• PLT count remained more than 150X 103/ µL , serum
  LDH was near normal and no schistocytes were
  visible on peripheral blood smear.

8
Plasma Hb 180 mg/L 20
mg/L
9
Serial changes in platelet counts and hemoglobin
in patient during her hospital stay after
receiving 12 cycles of plasma exchange and
steroids (5 units of PRBC transfusion were given
to correct anemia)
10
Serial changes in Serum LDH in patient during 12
cycles of TPE
11
THANK YOU