Therapeutic Plasma Exchange in Neurologic Disorders
Keywords:
Therapeutic Apheresis, Guillain-Barre Syndrome, Myasthenia Gravis, Chronic inflammatory demylinating polyneuropathy, Paraproteinemic Demyelinating Neuropathies, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), Sydenham's ChoreaAbstract
Therapeutic Apheresis is removing pathogenic cells/plasma from the patient and returning the normal components to alleviate disease symptoms. It is mainly Cytapheresis, Therapeutic plasma exchange (TPE), RBC exchange, LDL-apheresis, Immunoadsorption etc. The American Society for Apheresis has given guidelines on the grading recommendation, indication category and use of therapeutic apheresis in clinical practice. TPE involves removal of diseased plasma from the patient and simultaneous replacement by normal plasma or other fluids. Outcome and frequency of TPE depends on the rate of synthesis of the pathogenic substance and its distribution in the body. Life threatening complications are only 0.025 to 0.2% and are associated with the premorbid conditions of the patients rather than the procedure itself. The category I neurologic disorders where TPE is 1st line therapy are Guillain-Barre Syndrome, Myasthenia Gravis, Paraproteinemic demyelinating neuropathies, Chronic inflammatory demylinating polyneuropathy, Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and Sydenham's chorea.
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References
McLeod B. Therapeutic apheresis: history, clinical application and lingering uncertainties. Transfusion 2010; 50:1413-1426.
AABB Technical Manual, 18th ed 2014.
McLeod BC, Szczepiorkowski ZM, Weinstein R, Winters JL Eds. Apheresis: Principles and practice. 3rd edition Bethesda MD: AABB Press; 2010.
Szczepiorkowski ZM, Winters JL, Bandarenko N et al. Guidelines on the use of therapeutic apheresis in clinical practice–evidence-based approach from the American Society of Apheresis. J Clin Apher 2010;25:83 –177
Guyatt G, Gutterman D, Baumann MH et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of Chest Physicians task force. Chest 2006;129:174-181.
Schwartz J, Winter JL et al. Guidelines on the use of therapeutic apheresis in clinical practice–evidence-based approach from the writing Committee of American Society for Apheresis- The sixth special issue. J Clin Apher 2013;28:145–284.
Cortese I, Chaudhry V, So YT, Cantor F, Cornbalth DR, Rae Grant A. Evidencebased guidelines update: plasmapheresis in neurologic disorders: report of the Therapeutics and technology Assessment Subcommittee of the American Academy of Neurology 2011;76:294-300.
Mehndiratta MM, Hughes RA. Plasma exchange for chronic inflammatory d e m y e l i n a t i n g p o l y r a d i c u l o - neuropathy. Cochrane Database Syst Rev 2012; 9:CD003906.
Mandawat A, Kaminski H, Cutter G, Katirji B, Alshekhlee A. Comparative analysis of therapeutic options used for myasthenia gravis. Ann Neurol 2010; 68:797–805.
Rajabally UA. Neuropathy and paraproteins: review of a complex association. Eur J Neurol 2011; 18:1291–1298.
Ramchandren S, Lewis RA. An update on monoclonal gammopathy and neuropathy. Curr Neurol Neurosci Rep 2012; 12:102–110.
Swedo SE, Leckman JF Rose NR. From re s e a rc h s u b g ro u p to c l i n i c a l syndrome: modifying the PANDAS criteria to describe PANS (Pediatric Acute-onset Neuropsychiatric Syndrome). Pediatr Therapeut 2012;2:2.
