scholarly journals Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium

2021 ◽  
Vol 13 ◽  
pp. 117957352110573
Author(s):  
Fu Liong Hiew ◽  
Win Min Thit ◽  
Mathew Alexander ◽  
Umapathi Thirugnanam ◽  
Sasitorn Siritho ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Plasma Exchange ◽  
Neurological Diseases ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Therapeutic Plasma Exchange ◽  
Clinical State ◽  
First Line ◽  
Consensus Recommendation ◽  
Satisfactory Outcome

Therapeutic plasma exchange (TPE) is an effective and affordable treatment option in most parts of Southeast Asia (SEA). In 2018, the SEA TPE Consortium (SEATPEC) was established, consisting of regional neurologists working to improve outcome of various autoimmune neurological diseases. We proposed an immunotherapeutic guideline prioritizing TPE for this region. We reviewed disease burden, evidence-based treatment options, and major guidelines for common autoimmune neurological disorders seen in SEA. A modified treatment algorithm based on consensus agreement by key-opinion leaders was proposed. Autoimmune antibody diagnostic testing through collaboration with accredited laboratories was established. Choice of first-line immunotherapies (IVIg/corticosteroid/TPE) is based on available evidence, clinicians’ experience, contraindications, local availability, and affordability. TPE could be chosen as first-line therapy for GBS, CIDP, MG (acute/short term), IgG, A paraproteinemic neuropathy, and NMDAR encephalitis. Treatment is stopped for acute monophasic conditions such as GBS and ADEM following satisfactory outcome. For chronic immune disorders, a therapy taper or long-term maintenance therapy is recommended depending on the defined clinical state. TPE as second-line treatment is indicated for IVIg or corticosteroids refractory cases of ADEM, NMOSD (acute), MG, and NMDAR/LGI1/CASPR2/Hashimoto’s encephalitis. With better diagnosis, treatment initiation with TPE is a sustainable and effective immunotherapy for autoimmune neurological diseases in SEA.

scholarly journals Therapeutic Plasma Exchange in Guillain Barre Syndrome: An experience of Bangabanhu Sheikh Mujib Medical University, Bangladesh

2022 ◽  
Vol 4 (1) ◽  
pp. 11-13
Author(s):  
Sheikh Saiful Islam ◽  
Jannatul Ferdous ◽  
Ashraful Hoque ◽  
Atiar Rahman
Keyword(s):  
Plasma Exchange ◽  
Treatment Modality ◽  
Neurological Diseases ◽  
Treatment Options ◽  
Therapeutic Plasma Exchange ◽  
Guillain Barre Syndrome ◽  
Treatment Modalities ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
Medical University

Background: Therapeutic plasma exchange (TPE) has been used as one of the treatment modalities of neurological diseases. Intravenous Immunoglobulin (IVIG) and Therapeutic Plasma Exchange (TPE)are treatment options in Guillain Barre syndrome (GBS). In developing countries IVIG is not easily available and it is also expensive, TPE is preferred for treatment of GBS as it is affordable. Study on TPE for GBS are scarce here. Most of the study regarding TPE in GBS has been conducted in high –income countries as it is expensive treatment modality. Reports on TPE in GBS is very scared from Bangladesh. Materials and Methods: A retrospective analysis of TPE with a standard hemolysis equipment for the treatment of Guillain Barre syndrome (GBS) was conducted A 50 patients of GBS who received TPE conducted between January 2017 to December 2018 in the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh were analyzed. All patients had underdone at least 2 cycles of plasma exchange. Volume exchanged in each cycle was one plasma volume. Results: Out of 50 cases there were 43 (86%) male and 7 (14%) female.  Age range of patients was from 11 – 50 years. Approximately 40% improved clinically of first cycle of PE & 85% after second cycle, 95% after third cycle and 95-100% after 5 cycle. 1(2%) patient died, and 49(98%) patients survived and recovered. Conclusion: The treatment is cost affection in Compassion to IVIG. TPE is and affection, safe and affordable treatment modality for GBS.

scholarly journals Therapeutic Plasma Exchange as a Treatment for Autoimmune Neurological Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Ivana Nieto-Aristizábal ◽  
Álvaro J. Vivas ◽  
Pablo Ruiz-Montaño ◽  
Cristian C. Aragón ◽  
Iván Posso-Osorio ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Medical Records ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Neurological Diseases ◽  
Statistical Significance ◽  
Autoimmune Encephalitis ◽  
Therapeutic Plasma Exchange ◽  
Replacement Solution ◽  
Spectrum Disorders ◽  
Number Of Cycles

Introduction. Therapeutic plasma exchange (TPE) is commonly used as treatment of certain autoimmune neurological diseases (ANDs), and its main objective is the removal of pathogenic autoantibodies. Our aim was to describe the clinical profile and the experience with the usage of TPE in patients with ANDs at our institution. Methods. This is an observational retrospective study, including medical records of patients with diagnosis of ANDs who received TPE, between 2011 and 2018. Characteristics of TPE, such as number of cycles, type of replacement solution, and adverse effects, were evaluated. The modified Rankin Scale (mRS) was applied to measure the clinical response after the therapy. Results. 187 patients were included with the following diagnoses: myasthenia gravis (MG), n = 70 (37%); Guillain–Barré syndrome (GBS), n = 53 (28.3%), neuromyelitis optica spectrum disorders (NMOSD), n = 35 (18.7%); chronic inflammatory demyelinating polyneuropathy (CIDP), n = 23 (12.2%); and autoimmune encephalitis (AE), n = 6 (3.2%). The most used types of replacement solution were albumin (n = 131, 70%) and succinylated gelatin (n = 45, 24%). All patients received a median of five cycles (IQR 5-5). Hypotension and hydroelectrolytic disorders were the main complications. After TPE, 99 patients (52.9%) showed improvement in the mRS scores and a statistical significance (p<0.05) was seen between the admission score and after TPE for every diagnosis except for CIDP. Conclusion. TPE has an adequate safety profile, and improvement in functionality in treated patients reflects its effectiveness.

scholarly journals Plasmapheresis in neurological disorders: six years experience from University Clinical center Tuzla

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1234 ◽  
Author(s):  
Osman Sinanović ◽  
Sanela Zukić ◽  
Adnan Burina ◽  
Nermina Pirić ◽  
Renata Hodžić ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Clinical Response ◽  
Plasma Exchange ◽  
Neurological Diseases ◽  
Therapeutic Plasma Exchange ◽  
Motor Neuropathy ◽  
Extracorporeal Blood Purification ◽  
Clinical Center ◽  
Plasma Factor ◽  
Neurological Patients

Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy. Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016.   Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain–Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic’s disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%). Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.

scholarly journals Therapeutic Plasma Exchange – A 2 Years Experience at a Tertiary Care Centre in Mumbai, Maharashtra, India

2021 ◽  
Vol 10 (15) ◽  
pp. 1069-1073
Author(s):  
Moni Mukesh Udani ◽  
Akanksha Jivrag Neogi ◽  
Shweta Wasudeo Dhote ◽  
Iqbal Singh
Keyword(s):  
Plasma Exchange ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Complete Recovery ◽  
Therapeutic Plasma Exchange ◽  
Effective Procedure ◽  
Guillain Barre Syndrome ◽  
Tertiary Care Centre ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

BACKGROUND Therapeutic plasma exchange is a process where the blood collected from patient is passed through an apheresis instrument where the plasma is removed and discarded and reinfusion of blood cells done with replacement fluids like plasma or albumin to the patient.1 It is to remove pathogenic autoantibodies, immune complexes, cryoglobulins and toxins present in the plasma. Plasma exchange is considered effective and cheaper immunomodulatory treatment when compared to intravenous immunoglobulin (IVIG). 2 We present our institutional experience with therapeutic plasma exchange (TPE) in treatment of various non-neurological and neurological diseases. Our study was conducted to assess the indications, complications and outcome of TPE in the treatment of patients. METHODS A retrospective study of TPE procedures was carried out in the Department of Immunohaematology and blood transfusion, M.G.M Medical College and Hospital, Navi Mumbai from June 2018 to June 2020. A total of 45 procedures were performed among 13 patients between 4 years of age to 66 years of age. Clinical parameters were checked, and laboratory investigations were done before the procedure. Data was collected from the requisition forms by the clinicians and the apheresis database. RESULTS A total of 47 procedures were carried out among 13 patients. TPE is a safe and effective procedure for treating patients with neurologic and non-neurological diseases. Most common indication was Guillain Barre syndrome followed by myasthenia gravis. Incidence of adverse reactions was 7.6 %. CONCLUSIONS TPE is a safe and effective procedure for treating patients with neurologic and nonneurological diseases. It benefited 10 out of 13 patients, and they showed complete recovery. KEY WORDS Therapeutic Plasma Exchange, Guillain Barre syndrome

scholarly journals Distinct Approaches in Managing Adult and Pediatric Trigger Finger

2021 ◽  
Vol 6 (2) ◽  
pp. 28-35
Author(s):  
Putu Feryawan Meregawa ◽  
John Nolan
Keyword(s):  
Treatment Outcomes ◽  
Adult Population ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Age Groups ◽  
Ring Finger ◽  
Trigger Finger ◽  
Common Disease ◽  
Consensus Recommendation ◽  
Cost Effective Treatment

Background: Trigger finger is the most common disease that causing pain in the adult population. Trigger finger may occur at any finger, which usually occurs in the thumb and ring finger. A1 pulley sheath or metacarpal-phalangeal joint. There is a different recommendation toward treatment options for trigger fingers in adults and pediatrics. Method: This paper is done by reviewing and searching journals with “trigger finger”, “treatment”, “pediatric trigger finger”, and “adult trigger finger” on the search engines. The authors found 45 journals that were suitable for our references. Outcome: Trigger finger treatments vary as there are many acceptable treatment options. There is a different choice of therapy that should be considered in adult and pediatric trigger fingers. This should be considered to get better treatment outcomes. Cost analysis is also important to choose the most cost-effective treatment for trigger finger patients. Conclusion: There is no exact consensus recommendation for choosing the exact treatment. pediatric trigger finger is caused by a multifactorial aspect resulting in unpredictable conservative treatment outcomes unlike in adults. The majority of trigger fingers in pediatrics will need surgical procedures while some cases of adult trigger fingers may resolve naturally. Further large studies are needed to develop a treatment algorithm in these two age groups that trigger fingers. Keywords: adult trigger finger, trigger finger, pediatric trigger finger, treatment.

Therapeutic plasma exchange in patients with neurological diseases: Multicenter retrospective analysis

2013 ◽  
Vol 48 (3) ◽  
pp. 349-352 ◽  
Author(s):  
Emin Kaya ◽  
Muzaffer Keklik ◽  
Mehmet Şencan ◽  
Mehmet Yilmaz ◽  
Ali Keskin ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Retrospective Analysis ◽  
Neurological Diseases ◽  
Therapeutic Plasma Exchange

Therapeutic plasma exchange in neurological diseases: Eleven years experience a tertiary care center in Turkey

2021 ◽  
Author(s):  
Ahmet Seyhanli ◽  
Boran Yavuz ◽  
Ismail Selımoglu ◽  
İhsan Sukru Sengun ◽  
Abdullah Taha Aslan ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Neurological Diseases ◽  
Care Center ◽  
Tertiary Care ◽  
Therapeutic Plasma Exchange ◽  
Tertiary Care Center

scholarly journals Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence

2021 ◽  
Vol 12 ◽  
Author(s):  
Tina S. Ipe ◽  
Adeola R. Davis ◽  
Jay S. Raval
Keyword(s):  
Literature Review ◽  
Myasthenia Gravis ◽  
Plasma Exchange ◽  
Systematic Literature Review ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Treatment Options ◽  
Therapeutic Plasma Exchange ◽  
Cochrane Library ◽  
Pubmed Database

Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG.Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library.Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis.Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy. There was no difference in mortality between the two treatment options. Our findings highlight the need for additional randomized clinical trials in these patients with MG.

A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options – A Centre’s Experience

2015 ◽  
Vol 10 (01) ◽  
pp. 81
Author(s):  
Ilknur Kozanoglu ◽  
Yerdelen Deniz ◽  
Nurhilal Buyukkurt ◽  
Mahmut Yeral ◽  
Can Boga ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Severe Disease ◽  
Treatment Options ◽  
Axonal Neuropathy ◽  
Additional Treatment ◽  
Therapeutic Plasma Exchange ◽  
Guillain Barre Syndrome ◽  
Acute Motor Axonal Neuropathy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Therapeutic plasma exchange (TPE) has been shown to hasten recovery in Guillain-Barré syndrome (GBS). In this study, the objective was to show the outcome of disability grade in a retrospective analysis of data of clinical experience of TPE using the COBE Spectra Apheresis system and other treatment options in selected patients from a series of 56 patients with GBS at a single treatment centre in Turkey. Ten patients had the acute motor axonal neuropathy (AMAN) subtype; 46 had the acute inflammatory demyelinating polyneuropathy (AIDP) subtype of GBS. Three hundred and eighteen TPE procedures were performed taking 2 to 3 hours: in 6.3 % of them a peripheral catheter was used; in 93.7 % of them a central catheter was used. Replacement fluids were fresh frozen plasma (FFP), lactated Ringer’s solution or 3 % hydroxyethyl starch (HES). Among the patients, 12 (21.4 %) who had severe disease course received additional treatment to TPE - this was intravenous immunoglobulin (IVIG) in 11 patients. One patient was treated with steroids after rheumatology consultation due to another autoimmune disease. After 2 weeks, the mean GBS disability scores had significantly decreased from 3.75±0.48 to 2.44±0.96 (p=0.0001) and mean Medical Research Council (MRC) muscle strength scores significantly increased from 2.07±0.89 to 3.54±0.88 (p=0.0001). No difference in efficacy was observed between AMAN and AIDP subtypes. Adverse events occurred in 20 procedures (6.3 %) of TPE and were mostly transient hypocalcaemia and allergic reactions that did not necessitate treatment discontinuation. Difficulty in venous access was observed in 3.14 % of procedures. TPE using the COBE Spectra Apheresis system provides effective treatment of GBS with an acceptable safety profile using various replacement fluids and is an essential part of disease management. Although the benefit is controversial, other treatment options may be applied as an additional therapy in selected patients.

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