Therapeutic plasma exchange for neuromyelitis optica spectrum disorder: A multicenter retrospective study by the ASFA neurologic diseases subcommittee.

IMPORTANCE: Neuromyelitis optica/neuromyelitis optica spectrum disorder patients' response to therapeutic plasma exchange (TPE) is currently incompletely characterized. OBJECTIVE: Our study aims to understand the clinical status improvement of neuromyelitis optica/neuromyelitis optica spectrum disorder patients treated with TPE. DESIGN, SETTING, AND PARTICIPANTS: This is a multicenter retrospective study conducted between 1 January 2003 and 31 July 2017 at 13 US hospitals performing apheresis procedures. Subjects studied were diagnosed with neuromyelitis optica/neuromyelitis optica spectrum disorder who received TPE during presentation with acute disease. MAIN OUTCOMES AND MEASURES: The primary outcome was clinical status improvement in patients treated with TPE. Secondary measures were procedural and patient characteristics associated with response to treatment. RESULTS: We evaluated 114 patients from 13 institutions. There was a female predilection. The largest ethnic group affected was non-Hispanic Caucasian. The average age of diagnosis was 43.1 years. The average time to diagnosis was 3.1 years. On average, five procedures were performed during each treatment series. The most commonly performed plasma volume exchange was 1.0 to 1.25 using 5% albumin as replacement fluid. Most patients (52%) did not require an additional course of TPE and noted "mild" to "moderate" clinical status improvement. Maximal symptom improvement appeared by the fourth or fifth TPE treatment. CONCLUSION AND RELEVANCE: TPE improved the clinical status of patients. Adults responded more favorably than children. Procedural characteristics, including number of TPEs, plasma volume exchanged, and replacement fluid used, were similar between institutions. TPE was well-tolerated and had a low severe adverse event profile.

A centralized recipient database enhances the serologic safety of RBC transfusions for patients with sickle cell disease.

OBJECTIVES: To evaluate the utility of a centralized transfusion service model in preventing the transfusion of incompatible units in patients with sickle cell disease (SCD). METHODS: The serologic records of transfused patients with SCD were reviewed. The index hospital was where an alloantibody was initially detected. RESULTS: In total, 150 patients with SCD were evaluated; 66 (44.0%) of 150 were alloimmunized. In 42 (63.6%) of these patients, 1 or more antibodies evanesced. The median number of hospitals visited by patients with SCD for RBC transfusion with 1 or more evanesced antibodies was three (range, one to eight); the median number of nonindex hospitals was two (range, one to seven). Of the patients with evanesced antibodies, 28.6% received transfusions at various nonindex hospitals 20 or more times after the antibody evanesced. CONCLUSIONS: A centralized database can help identify patients with SCD who have evanesced alloantibodies and prevent issuing incompatible RBC units.