Experiences of Therapeutic Plasma Exchange in geriatric patients at a tertiary care hospital in western Maharashtra: An observational study

Abstract

Background

Geriatric patients undergo Therapeutic Plasma Exchange (TPE) for variety of indications that poses its unique challenges and complications. We present our experience with TPE in geriatric patients in terms of diseases encountered and adverse events, if any, witnessed during the procedure.

Methods

A prospective analysis of TPE procedures was done for a period of 01 year. Patients above 60 years of age with a range of 01–02 volume exchange per procedure were enrolled in the study. Baseline procedure investigations such as complete blood count, serum electrolytes, coagulation profile, and transfusion-transmitted infection screening were carried out before the TPE procedure. All TPE procedures were performed using a continuous-flow cell separator. All these patients were followed-up, and findings related to patients and procedures were documented.

Results

A total of 21 eligible enrolled patients underwent 85 procedures in the present study. Neurological disorders (80.9%, n = 17) were most common indication, with Guillain–Barre syndrome (42.8%, n = 9) being tthe most replaced by second common, followed by myasthenia gravis (23.8%, n = 5). Barring one, all other patients showed significant clinical response. The overall incidence of complications during the study was 80.9% (n = 17), among which majority were patient-related (94.11%, n = 16). However, only one procedure was terminated due to a machine error, and there were no procedure-related deaths.

Conclusion

The current study showed that TPE in geriatric patients gives substantial results in terms of clinical improvement but is fraught with multiple complications. However, in trained and expert hands, these complications can be managed effectively.