Patient outcome in antibody-positive systemic vasculitis treated with therapeutic plasma exchange

Aseem Kumar Tiwari; Divya Setya; Dhaval Tanna; Dinesh Arora; Geet Aggarwal; Rajiva Gupta; Shyam Bihari Bansal; Sidharth Kumar Sethi

doi:10.4103/ajts.AJTS_50_21

Patient outcome in antibody-positive systemic vasculitis treated with therapeutic plasma exchange

Asian J Transfus Sci. 2023 Jan-Jun;17(1):79-84. doi: 10.4103/ajts.AJTS_50_21. Epub 2023 Mar 1.

Authors

Aseem Kumar Tiwari¹, Divya Setya¹, Dhaval Tanna², Dinesh Arora¹, Geet Aggarwal¹, Rajiva Gupta², Shyam Bihari Bansal³, Sidharth Kumar Sethi³

Affiliations

¹ Department of Transfusion Medicine, Medanta - The Medicity, Gurgaon, Haryana, India.
² Department of Rheumatology and Clinical Immunology, Medanta - The Medicity, Gurgaon, Haryana, India.
³ Department of Nephrology, Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, Haryana, India.

Abstract

Background: Therapeutic plasma exchange (TPE) has been advocated as an adjunct to steroids and cytotoxic drugs in treating patients suffering from vasculitis and presenting with active disease, but we still have insufficient evidence on its effectiveness in improving the clinical response, especially in India. This study was planned to study the clinical outcome in severe vasculitic presentations treated with TPE as an adjunctive therapy.

Materials and methods: A retrospective analysis of TPE procedures performed from July 2013 to July 2017 in the department of transfusion medicine at a large tertiary care hospital was done. All consecutive patients admitted with new diagnosis of systemic vasculitis presenting with active disease and severe presentations such as advanced renal failure or severe respiratory abnormalities or life-threatening vasculitis affecting the gastrointestinal tract, neurological and musculoskeletal system; who needed TPE for removal of preformed antibodies, were included in the study.

Results: There were a total of 31 patients in whom TPE was performed for severe systemic vasculitis; 26 adults and five pediatric. Six patients tested positive for perinuclear fluorescence, 13 for cytoplasmic fluorescence (cANCA), two for atypical antineutrophil cytoplasmic autoantibody, seven for anti-glomerular basement membrane antibodies, two for antinuclear antibodies (ANA), and one patient tested positive for ANA as well as cANCA before the augmentation of TPE. Out of 31, seven patients showed no clinical improvement and succumbed to the disease. At the end of desired number of procedures, 19 tested negative and five tested weak positive for their respective antibodies.

Conclusion: Favorable clinical outcomes were observed with TPE in patients with antibody-positive systemic vasculitis.

Keywords: Anti-glomerular basement membrane; antineutrophil cytoplasmic autoantibody; antinuclear antibodies; diffuse alveolar hemorrhage; glomerulonephritis; therapeutic plasma exchange; vasculitis.