Therapeutic Plasma Exchange: Experiences at Square Hospital, Dhaka, Bangladesh

Introduction: The lowering of toxic level due to over dose of drugs or any metabolites is the cornerstone of all effective therapies in patient having such toxic condition. This procedure is basically an exchange technique which is carried out by deploying apharesis machine. Patient’s blood is passed through the machine, which filters plasma and removes and discards; simultaneously reinfuses red blood cells along with replacement of equivalent amount of fluid such as plasma or albumin into the patient. This procedure is commonly known as therapeutic plasma exchange (TPE), and its indication is assessed by the guidelines of ASFA. This study entails the experience in carrying out TPE in square hospitals Ltd, Dhaka, Bangladesh. Materials and Methods: Patients admitted in Square hospital with neurological and non-neurological conditions were assessed for the requirement of TPE and indication as per ASFA guidelines. Patients who consented for the study were included for the analysis. All TPE procedures were carried out in Intensive Care Unit (ICU) and High Dependency Unit (HDU) by blood bank technologists trained in TPE under the supervision of blood bank physician. All patients were assessed throughout the intra-procedure and post-procedure thoroughly to observe and identify any complications or adverse reactions. Results: Total 50 patients were indicated for TPE; of which 25 were male and 25 females with mean age of 39.6 years, range: 09 to 68 years (Table-1). Among the five age group strata, majority of patients (42%) were from 31-45 years followed by 46-60 years (24%) and the details are followed hereafter. Discussion: Plasma exchange (PE), a therapeutic procedure used to treat a variety of diseases through the bulk removal of plasma. Since the initial use, the term has been describing more broadly of several procedures, all of which involve the separation of whole blood into its components with removal modification of one or more of these components. The PE when introduced in clinical practice has significantly reduced the morbidity and mortality of patients with various diseases, TPE has been reported to be of greater potential benefit than IVIG. In our experience, TPE is more effective when initiated within seven days of disease onset, for controlling symptoms of neuro-immunological disorders. Conclusion: The possibility of complications must be weighed carefully before deciding to use plasma exchange therapy. Careful assessment of the patients and expertise in TPE is essential to optimize therapy and minimize adverse consequences.