Therapeutic Plasma Exchange (TPE) Complications in Patients With Multiple Sclerosis (MS) and Clinically Isolated Syndrome (CIS)

Abstract

Background: Therapeutic plasma exchange (TPE) is a conventional second-line treatment for patients with multiple sclerosis (MS) or clinically isolated syndrome with steroid-refractory relapses.Methods: MS and clinically isolated syndrome patients with a steroidrefractory relapse, who fulfilled the indications for TPE were enrolled in this study. An expert nurse recorded the data comprising age, sex, type of MS, disease modifying therapy, disease duration, relapse rate, vital signs at the beginning, during and at the end of each plasma exchange session, plasma exchange volume, normal saline volume, and TPE complications. Ultimately, the statistical association was estimated amongst the variables.Results: A total of 122 cases were assessed. Twelve cases (9.8%) received plasmapheresis for the second time. The mean age was 32.2 8.7 years and 107 (87.7%) were female. In total, 609 plasma exchange sessions were completed. Hypotension and skin reaction were the most clinical complications. Hemoglobin loss and hypokalemia were the most laboratory complications. Fifty-four cases (44.3%) had no complications, 40 (32.8%) had 1 complication, 21 (17.2%) 2 complications, 6 (4.9%) had 3 complications, and 1 (0.8%) disclosed 4 complications. The relapse rate in the past 12 months and the mean plasma volume exchange were significantly different between the groups.Conclusions: We revealed that TPE could be considered as a safe secondline therapy in MS relapses. Hypotension, skin reaction, hemoglobin loss, and hypokalemia were the most complications of TPE in our patients.

Early clinical response and complications of therapeutic plasma exchange in central nervous system demyelinating diseases

“… 21 Mavandadi et al found that hypotension and skin rash, a plasmapheresis systemic reaction, were the most common clinical complications and hypokalemia was one of the most common laboratory complications, as our study confirmed. 32 Seyhanli et al identified allergic reactions and hypotension as the two most common complications of TPE due to the treatment of different neurological diseases in a tertiary center in Turkey. 33 Anaphylactic reactions or mild toxic reactions to citrate, which were previously reported as self-limiting complications of TPE, did not occur in our study.…”