Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians
Xiao Jiang, Amit Kansal, Monika G Kansal, Faheem A Khan, Chee Keat Tan, Patricia Leong, Marjoyna Ortal, Rajat Tagore, Prashanth Ramesh, Shekhar Dhanvijay
Feasibility, Intensive care unit, Membrane-based, Plasma exchange, Safety
Citation Information :
Jiang X, Kansal A, Kansal MG, Khan FA, Tan CK, Leong P, Ortal M, Tagore R, Ramesh P, Dhanvijay S. Feasibility and Safety of Implementing Membrane-based Plasma Exchange in a Low-volume Center: Retrospective Single Center Experience Over 3 Years Including Multidisciplinary Survey among Clinicians. 2023; 2 (2):54-60.
Background: Membranous therapeutic plasma exchange (mTPE) is less commonly used in Singapore compared to centrifuge TPE. Our study aimed to investigate the feasibility and safety of mTPE as a new service in a low-volume TPE center that was familiar and experienced with the continuous renal replacement therapy (CRRT) technique.
Materials and methods: This was a single-center retrospective study of patients who underwent mTPE from 1st May 2018 to 31st July 2021, conducted at a 34-bedded mixed intensive care unit (ICU) in Singapore. Clinical data and mTPE details, including adverse events, were collected for all sessions. Multidisciplinary surveys of specialists and nurses involved were conducted thereafter in August 2021.
Results: During the study period, a total of 53 mTPE sessions were done for 10 patients, of which eight (80%) were female. Of a total of 53 sessions, filter clotting despite anticoagulation occurred in seven (13%) sessions. The adverse event rate was 11.3% of all sessions. A survey of five specialists and 12 ICU nurses indicated a smooth referral process, a short setup time, and easy hands-on in implementing mTPE as a new service in the ICU.
Conclusion: Our results show the feasibility and safety of introducing mTPE as a new service in ICU settings in a low-volume TPE center, with the specific logistical advantage of short training time in view of familiarity and experience with the CRRT technique. This also provided the ability to continue uninterrupted service during the pandemic and maybe a future direction for similar ICUs.
Solomon BA, Castino F, Lysaght MJ, et al. Continuous flow membrane filtration of plasma from whole blood. Trans Am Soc Artif Intern Organs 1978;24:21–26.
Tan HK, Hart G. Plasma filtration. Ann Acad Med Singap 2005;34:615. https://annals.edu.sg/pdf/34VolNo10200511/V34N10p615.pdf
Ahmed S, Kaplan A. Therapeutic plasma exchange using membrane plasma separation. Clin J Am Soc Nephrol 2020;15(9):1364–1370. DOI: 10.2215/CJN.12501019
Kes P, Janssens ME, Bašić-Jukić N, et al. A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures. Transfusion 2016;56(12):3065–3072. DOI: 10.1111/trf.13850
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
Hwang WY, Chai LY, Ng HJ, et al. Therapeutic plasmapheresis for the treatment of the thrombotic thrombocytopenic purpura-haemolytic uraemic syndromes. Singapore Med J 2004;45(5):219–223. https://www.sma.org.sg/smj/4505/4505a3.pdf
Tan AWK, Lim BSP, Hoe JKM, et al. Therapeutic plasma exchange for control of thyroid storm. J Clin Apher 2021;36(1):189–195. DOI: 10.1002/jca.21832
RamachandranNair R, Parameswaran M, Girija AS. Acute disseminated encephalomyelitis treated with plasmapheresis. Singapore Med J 2005;46(10):561–563. https://www.sma.org.sg/smj/4610/4610cr2.pdf
Connelly-Smith L, Dunbar NM. The 2019 guidelines from the American Society for Apheresis: what's new? Curr Opin Hematol 2019;26(6):461–465. DOI: 10.1097/MOH.0000000000000534
Kamran SM, Mirza ZE, Naseem A, et al. Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study. PLoS One 2021;16(1):e0244853. DOI: 10.1371/journal.pone.0244853
Yilmaz AA, Can ÖS, Oral M, et al. Therapeutic plasma exchange in an intensive care unit (ICU): a 10-year, single-center experience. Transfus Apher Sci 2011;45(2):161–166. DOI: 10.1016/j.transci.2011.04.008
Bauer PR, Ostermann M, Russell L, et al. Plasma exchange in the intensive care unit: a narrative review. Intensive Care Med 2022;48(10):1382–1396. DOI: 10.1007/s00134-022-06793-z
Córdoba JP, Larrarte C, Medina MC. Experience in therapeutic plasma exchange by membrane filtration at an academic center in Colombia: registry of the first 500 sessions. J Clin Apher 2015;30(6):347–352. DOI: 10.1002/jca.21391