Therapeutic Plasma Exchange in the Management of Myasthenia Crisis in a Resource Poor Setting

BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.

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Should Open Surgery or Conservative Management be the Choice for Treatment of Ectopic Pregnancy during COVID-19 Pandemic in a Resource-Poor Setting? A Case Series from India.

10.21203/rs.3.rs-85956/v1 ◽

2020 ◽

Author(s):

Rahi Pednekar ◽

Niraj N Mahajan ◽

Deepika Tirkey ◽

Geeta Kulkarni ◽

Ankita Pandey ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Case Series ◽

Limited Resource ◽

Fixed Dose ◽

Resource Poor Setting ◽

Surgical Smoke ◽

Medical College ◽

Resource Setting ◽

Resource Poor ◽

Ectopic Pregnancies

Abstract Background: As the COVID-19 pandemic is progressing, it is posing several challenges for management of health emergencies either by direct impact or through the restrictive policies adopted by several nations worldwide. Currently, there is no information on management of ectopic pregnancies associated with COVID-19 in low resource settings. We report the management of three cases of ectopic pregnancies in a limited resource setting and also describe the challenges we faced in managing these cases at a dedicated COVID-19 hospital in India.Case presentation: T.N. Medical College & B.Y.L. Nair Charitable Hospital (NH) received three asymptomatic, RT-PCR confirmed COVID-19 women with ectopic pregnancy (EP). One was caesarean scar pregnancy (CSP), diagnosed on ultrasound and CT examination and managed with multiple fixed dose methotrexate therapy. Other two cases were ruptured EP managed surgically by laparotomy avoiding laparoscopy to reduce the risk of possible viral transmission.Conclusions: Based on our experience, we recommend laparotomy as an option for surgical management of EP in resource poor settings. It is useful for prevention of possible transmission of SARS-CoV-2 infection to healthcare workers from surgical smoke and it is wiser to take a conservative approach in managing EP wherever possible. More studies are needed to completely disregard the possibility of presence of viable SARS-CoV-2 particles in surgical smoke. There is a need to formulate specific guidelines to address the collateral damage.

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Is There a Role for Plasma Exchange in ANCA-Associated Vasculitis?

Current Treatment Options in Rheumatology ◽

10.1007/s40674-020-00161-y ◽

2020 ◽

Vol 6 (4) ◽

pp. 313-324

Author(s):

Maria Prendecki ◽

Stephen P. McAdoo ◽

Charles D. Pusey

Keyword(s):

Adverse Events ◽

Small Molecules ◽

Plasma Exchange ◽

Immunosuppressive Drugs ◽

Therapeutic Plasma Exchange ◽

Serious Adverse Events ◽

End Point ◽

Anca Associated Vasculitis

Abstract Purpose of review This review summarises the evidence for the use of therapeutic plasma exchange (TPE) in anti-neutrophil cytoplasm antibody (ANCA)–associated vasculitis. TPE is an extra-corporeal treatment which efficiently removes IgG and other pathogenic small molecules from the blood. There are several mechanistic reasons why this should be of benefit in AAV including the well-described pathogenicity of ANCA. Recent findings The recently published PEXIVAS trial is the largest study of TPE in AAV to date. It did not show a benefit for adjunctive TPE on a primary end point of ESRD or death. There was no difference in serious adverse events between those treated with TPE and those treated with immunosuppressive drugs alone. Conclusions Based on the results of PEXIVAS, most patients with AAV should not be treated with adjunctive TPE. However, there are subgroups of patients with AAV for whom TPE may still be of benefit, including those with double positivity for anti-GBM antibodies and ANCA.

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Efficiency of Therapeutic Plasma-Exchange in Acute Interstitial Lung Disease, Associated With Polymyositis/Dermatomyositis Resistant to Glucocorticoids and Immunosuppressive Drugs: A Retrospective Study

Frontiers in Medicine ◽

10.3389/fmed.2019.00239 ◽

2019 ◽

Vol 6 ◽

Author(s):

Yaogui Ning ◽

Guomei Yang ◽

Yuechi Sun ◽

Shiju Chen ◽

Yuan Liu ◽

...

Keyword(s):

Retrospective Study ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Plasma Exchange ◽

Immunosuppressive Drugs ◽

Therapeutic Plasma Exchange

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Rationale of Therapeutic Plasma Exchange as Rescue Immunomodulatory Treatment for MIS-C With Multiorgan Failure

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000003169 ◽

2021 ◽

Vol 40 (7) ◽

pp. e259-e262

Author(s):

Franco Díaz ◽

Camila Cores ◽

Omar Atenas ◽

Nicolás Rodríguez ◽

Raúl Bustos ◽

...

Keyword(s):

Plasma Exchange ◽

Multiorgan Failure ◽

Therapeutic Plasma Exchange ◽

Immunomodulatory Treatment

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Therapeutic Plasma Exchange Application in Children Requires Individual Decision

Journal of Pediatric Intensive Care ◽

10.1055/s-0040-1714098 ◽

2020 ◽

Author(s):

Gürkan Atay ◽

Demet Demirkol

Keyword(s):

Plasma Exchange ◽

Vascular Access ◽

Pediatric Patients ◽

Demyelinating Disease ◽

Pediatric Intensive Care ◽

Therapeutic Plasma Exchange ◽

Transplantation Rejection ◽

Access Problems ◽

Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

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