Therapeutic Plasma Exchange Using Fresh-Frozen Plasma and Albumin Solution as a Replacement Fluid: A 21-Year Single-Center Experience

Introduction. Plasmapheresis is considered a powerful tool in clinical medicine and is indicated in a diverse heterogeneous variety of disorders. The aim of our study was to assess the overall efficacy and safety of therapeutic plasma-exchange (TPE) using fresh-frozen plasma (FFP) and albumin solution as a replacement fluid. Methods. This is a retrospective collection and analysis of data obtained from the records of all patients who underwent TPE during the last 21 years, in our hospital. A total of 2077 sessions of TPE were performed in 294 patients (163 males and 131 females, 16-81 years old), concerning 312 TPE cases (294 patients with 18 relapses). In all cases a combination of FFP and albumin solution was used as a replacement fluid. The main reasons for TPE application were hematological diseases (166 cases-53.2%), diseases of neurological system (48 cases-15.3%) and renal diseases with or without ANCA positive systemic vasculitis (45 cases-14.4%). Results. In 179 cases (57.3%) a partial or complete response of the situation for which the patients underwent TPE was achieved. In the remaining cases the initial situation did not change or the patients died. Only 127 cases (40.7%) were included in category I indications for plasmapheresis, according to ASFA guidelines. Urticaria and anaphylactoid reactions (8 cases), ARDS (2), respiratory arrest (1), myocardial infraction (1) and arterial hypotension (33), were recorded as major but non-fatal complications during the performance of TPE sessions. Seventy-four of the patients (25.1%) died during hospitalization. Conclusion. TPE, using both FFP and albumin solution as replacement fluid, is a therapeutic method accompanying with only few major complications and is particularly effective in certain diseases.