Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune aetiology was known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university hospitals.

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2. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 5 6 e2 5 7
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
Journal Scan
Therapeutic plasma exchange in patients with
neurologic diseases: Retrospective multicenter
study
R.N. Makroo a,*, Aakanksha Bhatia b
a Director Professor and Sr. Consultant, Department of Transfusion Medicine, Transplant Immunology & Molecular
Biology, Indraprastha Apollo Hospitals, New Delhi, India
b Registrar, Department of Transfusion Medicine, Transplant Immunology & Molecular Biology, Indraprastha Apollo
Hospitals, New Delhi, India
Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Leylagul Kaynar, Fevzi
Altuntas, Ismet Aydogdu, Burhan Turgut, Ismail Kocyigit, Sibel Kabukcu Hacıoglu, Sevda Ismailogulları, Nilda Turgut, M. Ali
Erkurt, Ismail Sari, Mehmet Oztekin, Musa Solmaz, Bulent Eser, Ali Ozdemir Ersoy, Ali Unal, Mustafa Cetin. Transfus Apher
Sci. April 2008;38(2):109e115.
Abstract
Therapeutic plasma exchange (TPE) is commonly used in many neurological disorders where an immune aetiology was
known or suspected. We report our experience with TPE performed for neuroimmunologic disorders at four university
hospitals.
The study was a retrospective review of the medical records of neurological patients (n ¼ 57) consecutively treated with
TPE between April 2006 and May 2007. TPE indications in neurological diseases included GuillaineBarre` Syndrome (GBS)
(n ¼ 41), myasthenia gravis (MG) (n ¼ 11), acute disseminated encephalomyelitis (ADEM) (n ¼ 3), chronic inflammatory
demyelinating polyneuropathy (CIDP) (n ¼ 1) and multiple sclerosis (MS) (n ¼ 1). Patient median age was 49; there was a
predominance of males. Twenty-two patients had a history of other therapy including intravenous immunoglobulin (IVIG),
steroid, azathioprine, and pyridostigmine prior to TPE. Another 35 patients had not received any treatment prior to TPE. All
patients were classified according to the Hughes functional grading scores pre- and first day post-TPE for early clinical
evaluation of patients.
The TPE was carried out 1e1.5 times at the predicted plasma volume every other day. Two hundred and ninety-four
procedures were performed on 57 patients. The median number of TPE sessions per patient was five, and the median
processed plasma volume was 3075 mL for each cycle. Although the pre-TPE median Hughes score of all patients was 4, it
had decreased to grade 1 after TPE. While the pre-TPE median Hughes score for GBS and MG patients was 4, post-TPE scores
were decreased to grade 1. Additionally, there was a statistically significant difference between post-TPE Hughes score for
GBS patients with TPE as front line therapy and patients receiving IVIG as front line therapy (1 vs. 3.5; p ¼ 0.034). Although
there was no post-TPE improvement in Hughes scores in patients with ADEM and CIDP, patients with MS had an improved
Hughes score from 4 to 1. Mild and manageable complications such as hypotension and hypocalcemia were also observed.
TPE may be preferable for controlling symptoms of neuro-immunological disorders in early stage of the disease, espe-cially
with GBS.
* Corresponding author.
E-mail address: makroo@apollohospitals.com (R.N. Makroo).
0976-0016/$ e see front matter
http://dx.doi.org/10.1016/j.apme.2013.08.002

3. Comments
a pol l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 5 6 e2 5 7 257
Therapeutic plasma exchange has been accepted as an
important treatment modality in patients with various
neurological diseases. The authors have demonstrated with
success, a good response to 1e1.5 volume plasma exchanges in
most of their cases especially in patients of Myasthenia Gravis
and GuillaineBarre` Syndromes. Favourable response was also
observed in patients with Multiple Sclerosis. They have also
demonstrated that the procedure is not only effective but also
safe, with only minimal adverse reactions in few patients,
which were not severe enough to interrupt the procedures.
The Indraprastha Apollo Hospitals, being an advanced
tertiary care and referral centre caters to a large number of
patients from all disciplines of medicine. With a busy plasma
exchange programme, we successfully treat patients with
renal, neurological and haematological disorders among
others. We have encountered 26 cases with neurological dis-eases,
which include 11 cases of Myasthenia Gravis and 9
cases of GBS among others in our experience so far. These
have been treated with 1e5 sittings of 1e1.5 volume ex-changes
each. Eighteen of them showed definite clinical
improvement, while 6 did not. Two patients were lost to
follow up.

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