Changes in Indications for Therapeutic Plasma Exchange Over the Last 27 Years in Croatia

Abstract

Results from recent trials and advances in the fields of medicine and technology have altered the spectrum of indications for use of therapeutic plasma exchange. In this article we analyze changes in indications for therapeutic plasma exchange that have occurred during 27 years in Croatia. We retrospectively analyzed the database of the Department of Dialysis at the University Hospital Center, Zagreb (678 patients; 6596 procedures), for changes in indications for therapeutic plasma exchange from 1982 to 2008. The number of patients and procedures increased several-fold during the follow-up period, but the mean number of procedures per patient per year did not change significantly. Neurological disorders constituted the largest group of indications for therapeutic plasma exchange (66% of all indications), followed by hematological (16%), nephrological (6%), and rheumatological disorders (6%). Myasthenia gravis was the most frequent indication during the entire follow-up period, but the pattern of other indications changed, with the most frequent at the beginning of follow-up becoming the least frequent at the end of follow-up. The five most frequent indications represented 62.2% of all indications at the beginning of follow-up, whereas during the 1990s, this percentage increased to more than 90% of all indications. Since the year 2000, the spectrum of indications has grown, and the percentage of the five most common indications decreased to 79.9%. Despite changes in indications for therapeutic plasma exchange, this procedure is still applicable in various medical fields, either traditional or newly created with the development of medicine and technology.

Membrane therapeutic plasma exchange with and without heparin anticoagulation

“…Our findings, which were derived from a large number of procedures (9,589), indicate that TPE can be conducted safely with UH and, when necessary, without anticoagulation. LMWH does not appear to be as effective.…”

“…8 In addition, changes in the indications for TPE because of augmentation in hematological indications also may have contributed to changes in anticoagulation use. 2,9,10 These changes may also have contributed to higher incidence of complications in the last period of our study ( Table 5 and 6).…”

“…Changes in anticoagulation use are a consequence of changes in characteristics of the treated population, who became older and have more concomitant diseases . In addition, changes in the indications for TPE because of augmentation in hematological indications also may have contributed to changes in anticoagulation use . These changes may also have contributed to higher incidence of complications in the last period of our study (Table and ).…”

Therapeutic Plasma Exchange in Tehran Between 2011 and 2014

“…However, since 1990, endocrine diseases have become the most important activity of apheresis. Under the neurological category, this multicentric study included Guillain–Barré and myasthenia gravis as the major indications, with the most frequent hematological diseases being TTP and HUS . In our study, results of neurological and hematologic diseases were approximately similar, although there is no national registration involved.…”

Therapeutic plasma exchange in patients in a portuguese ICU

“…Although neurologic diseases are the most common reason for TPE in many ICU cases series, registries show a decrease in the number of TPE procedures over time, partially attributed to the decrease of TPE procedures performed in patients with Guillain -Barré syndrome 10 . Recent studies 12,18,19 have shown similar outcomes between treatment with TPE or intravenous immunoglobulin in Guillain -Barré syndrome and many centers, like ours, started to use intravenous immunoglobulin as first--line therapy and reserve TPE for patients who do not respond to intravenous immunoglobulin 10,14 . In fact, only one patient with Guillain -Barré syndrome was treated with plasmapheresis in our study, in accordance with the most recent epidemiological data.…”