Incorporating Membrane: Plasma Exchange in Critical Care

Limesh Marisiddappa

Department of Nephrology, Narayana Health City, Bengaluru, Karnataka, India

Corresponding Author: Limesh Marisiddappa, Department of Nephrology, Narayana Health City, Bengaluru, Karnataka, India, Phone: +91 9663889093, e-mail: namanmukunda@gmail.com

How to cite this article: Marisiddappa L. Incorporating Membrane: Plasma Exchange in Critical Care. J Acute Care 2023;2(2):45–45.

Source of support: Nil

Conflict of interest: None

At the outset, I would like to thank the editorial board for inviting me to write the editorial for this esteemed Journal of Acute Care. In 1952, therapeutic plasma exchange (TPE) was initially started, and it was Micheal Rubinstein who first employed in the treatment of thrombotic thrombocytopenic purpura in 1959.¹ Dr Victor Grifils-Lucas, in 1965, patented the device, which performed an automatic and continuous separation of blood components.² All major guidelines strongly recommend TPE for autoimmune disorders, such as antineutrophil cytoplasmic antibody-associated vasculitis.³^,⁴ Membrane separation is not very helpful for the separation of individual blood components. However, the centrifugal technique has a very high extraction ratio (approximately 100%).⁵^-⁷

In the current issue of the Journal of Acute Care, authors have highlighted the need to implement a critical technology in the care of sick patients. The expertise available at the current hospital was restricted only to continuous renal replacement therapy (CRRT). However, in dire circumstances, the authors have implemented the plasma exchange using the CRRT machines. Trained nurses and technicians are the backbones of the therapy. In this paper, the training and critical role played by them has been highlighted. The knowledge and expertise need to be passed on for the technology to percolate and utilization of the benefit of the patients. The mortality in this study compared to other studies is almost similar. The aggressive disease itself has high mortality. The authors have clearly explained the methodology of membrane plasma exchange. Although there is no novel technology demonstrated here, adaptation to accommodate the technology needs to be applauded. Last but not least, the strain on limited resources was eased, especially during the coronavirus disease of 2019 pandemic. Hopefully, low-volume centers across the globe can similarly implement the same and continue to serve sick patients.

REFERENCES

1. Strauss RG, Ciavarella D, Gilcher RO, et al. An overview of current management. J Clin Apher 1993;8(4):189–194. DOI: 10.1002/jca.2920080402

2. Wallace DJ. Apheresis for lupus erythematosus. Lupus 1999;8(3):174–180. DOI: 10.1191/096120399678847669

3. Hafer C, Golla P, Gericke M, et al. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. Int Urol Nephrol 2016;48(1):133–138. DOI: 10.1007/s11255-015-1137-3

4. Schmidt JJ, Asper F, Einecke G, et al. Therapeutic plasma exchange in a tertiary care center: 185 patients undergoing 912 treatments - a one-year retrospective analysis. BMC Nephrol 2018;19(1):12. DOI: 10.1186/s12882-017-0803-3

5. Plasmaflo OP digital catalog: Available at:http://www.asahi-kasei.co.jp/medical/en/apheresis/product/plasma/op/performance.html.

6. Kaplan AA. Toward the rational prescription of therapeutic plasma exchange: the kinetics of immunoglobulin removal. Semin Dial 2007;5(3):227–229. DOI: 10.1111/j.1525-139X.1992.tb00482.x

7. Padmanabhan A, Connelly-Smith L, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the Writing Committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 2019;34(3):171–354. DOI: 10.1002/jca.21705

________________________
© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.