Urgent therapeutic plasma exchange

Abstract

Therapeutic plasma exchange (TPE) is a well-established therapeutic procedure commonly used in many disorders of autoimmune etiology. The beneficial effects of TPE occur through the removal of pathognomonic inflammatory mediators; including autoantibodies, complement components, and cytokines. The use of TPE in the emergency setting is limited to a few indications. In this chapter, we focus on four conditions that we are most frequently faced with in the urgency setting: neuromyelitis optica-spectrum disorders, solid organ transplantation, and two metabolic conditions such as major hypertriglyceridemia and hyperthyroidism. We discuss the clinical setting defining the urgent character of TPE, the timing of treatment onset, the therapeutic pattern of TPE and the level of evidence currently available for each condition.

Keywords: Plasma exchange; apheresis; emergency; hypertrhyroidism; hypertriglyceridemia; neuromyelitis optica spectrum disorders; organ transplantation.