Complications of membrane-filtration plasma exchange.

BACKGROUND

Plasma exchange (PE) has been extensively used to treat a variety of disease states in the past three decades. Although PE is commonly thought to be a relatively safe procedure, a number of unpleasant side effects may occur. To highlight the need for continuing quality assurance in providing PE service, a retrospective review of PE records over a 13-year period was undertaken.

METHODS

From April 1983 to March 1996, 694 therapeutic PE procedures, membrane-filtration type, were performed on a total of 157 patients in this hospital. Plasmaflo op-05(L) (Asahi Japan) was used as the plasma separator and fresh frozen plasma of one plasma volume as replacement fluid. The PE sheets for all procedures were reviewed as were medical charts in order to evaluate clinical efficacy.

RESULTS

Totally 694 PEs in 157 patients, 84 male and 73 females, ranging in age from 1 to 75 years (median, 35 years), were treated. Patients received a median of 4 treatments (range, 1 to 34). The most frequent indications were severe jaundice (41.4%), systemic lupus erythematosus (23.6%), and myasthenia gravis (15.3%). The overall effective rate was 40.8%, and was best in neurological diseases (91.4% effective). Complications of PE were noted during 36% of the procedures involving 59.2% of the patients treated. The most common adverse reactions were paresthesia (12.7%), chills (10.2%), urticaria (8.5%), chest pain (5.9%), nausea (2.9%) and dyspnea (2.0%). Less common complications included: catheter infection (0.3%), catheter oozing (1.2%), dizziness (1.3%), headache (0.4%), muscle cramps (1.3%), vomiting (0.4%), abdominal pain (0.9%), fever (0.3%), hypotension (1.3%), bleeding (0.4%), consciousness change (0.7%) and respiratory arrest (0.4%). These complications were classified as "mild" (23%), "moderate" (11.4%) and "severe" (1.6%). No deaths occurred within 24 hours after PE.

CONCLUSIONS

Although the use of membrane-filtration PE represents a valuable and relatively safe therapy, some life-threatening reactions do occur.