Low-volume Plasma Exchange In Immune-mediated Neurological Diseases : A tertiary care center study

Aashish Shrestha, B. Gajurel, R. Karn, R. Ojha, R. Rajbhandari, N. Gautam, Sumit Shahi, P. Ghimire, Pradeep Panthee, S. Bijukchhe
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Abstract

BACKGROUND The optimal cost benefit of standard plasma exchange (SPE) has not been met where most of the patients do not afford the treatment. As an alternative, low volume plasma exchange (LVPE) is cost-effective than SPE where albumin replacement is eliminated. The aim of this study was to analyse the efficacy and safety of LVPE in various Immune mediated neurological diseases (IMND). METHODS A hospital-based retrospective study was conducted in patients with IMND who were admitted in TUTH between October 15, 2020, and October 14, 2022. Hemodynamically stable patients over the age of 18 who met the plasma exchange criteria were eligible. Outcomes and treatment-related complications were studied separately for the different diseases. RESULTS Of the 29 patients enrolled, 3 had Myasthenia gravis (MG), 6 had Neuromyelitis optica spectrum disorder (NMOSD), 11 had Gullian Barre syndrome (GBS), 6 had Chronic inflammatory demyelinating polyneuropathy (CIDP), and 3 had Autoimmune encephalitis (AE). Patients with MG, GBS, and CIDP all showed statistically significant improvement in mRS scores from 2.3±0.6 to 0 (p value = 0.0198), 3.03±1.8 to 2.2±1.4 (p value=0.0046) and 2.5±1.4 to 1.8±1(p value=0.025) respectively by the time they were discharged following treatment. Two patients developed Deep vein thrombosis (DVT), and two developed anaphylaxis during the course of their treatment, although none deteriorated further while in the hospital. CONCLUSION LVPE was effective in MG, GBS and CIDP. Myasthenia crisis patients who re-quired mechanical ventilation demonstrated complete resolution with LVPE making it a potential life-saving alternative for those who cannot afford standard therapy.
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免疫介导的神经系统疾病的低容量血浆交换:一项三级保健中心研究
背景:标准血浆置换(SPE)的最佳成本效益尚未得到满足,因为大多数患者负担不起治疗费用。作为替代方案,低容量血浆交换(LVPE)比SPE更具成本效益,无需白蛋白替代。本研究的目的是分析LVPE在各种免疫介导的神经系统疾病(IMND)中的疗效和安全性。方法:对2020年10月15日至2022年10月14日期间在TUTH住院的IMND患者进行基于医院的回顾性研究。符合血浆交换标准的18岁以上血流动力学稳定的患者符合条件。分别对不同疾病的治疗结果和治疗相关并发症进行研究。结果入选的29例患者中,3例为重症肌无力(MG), 6例为视神经脊髓炎谱系障碍(NMOSD), 11例为Gullian Barre综合征(GBS), 6例为慢性炎症性脱髓鞘性多神经病变(CIDP), 3例为自身免疫性脑炎(AE)。MG、GBS、CIDP患者治疗出院时mRS评分分别由2.3±0.6分改善至0分(p值= 0.0198)、3.03±1.8分改善至2.2±1.4分(p值=0.0046)、2.5±1.4分改善至1.8±1分(p值=0.025),均有统计学意义。两名患者出现深静脉血栓形成(DVT),两名患者在治疗过程中出现过敏反应,尽管在医院期间没有进一步恶化。结论LVPE治疗MG、GBS、CIDP均有效。需要机械通气的重症肌无力危重患者显示出LVPE的完全解决方案,使其成为无法负担标准治疗费用的患者的潜在救生选择。
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