Recambio plasmático terapéutico: aplicaciones en neurología / Therapeutic plasma exchange: applications in neurology

Introducción. El recambio plasmático es una técnica utilizada en el tratamiento de algunas enfermedades neurológicas de base autoinmune desde los años ochenta, especialmente en situaciones agudas. En los últimos años se han publicado nuevos datos sobre su empleo en numerosas entidades con base autoinmune, ampliando, con ello, el espectro de utilización. Objetivo. Actualizar las indicaciones de esta técnica en el tratamiento de las enfermedades neurológicas. Desarrollo. Se ha realizado una revisión exhaustiva de todos los artículos publicados desde los años ochenta sobre la eficacia del recambio plasmático en el tratamiento de las diferentes enfermedades neurológicas. También se ha efectuado un análisis detallado de las recomendaciones y evidencias de la utilización de este procedimiento por parte de las diferentes sociedades científicas. Conclusiones. El recambio plasmático ha demostrado ser una alternativa eficaz con evidencia científica de primer nivel en enfermedades como el síndrome de Guillain-Barré, la polineuropatía desmielinizante inflamatoria crónica o la miastenia grave. Ha mostrado ser eficaz en el tratamiento de episodios desmielinizantes agudos sin respuesta a otras terapias, en los brotes de neuromielitis óptica y en otras enfermedades del sistema nervioso central producidas por anticuerpos. En los estudios comparativos con inmunoglobulinas intravenosas, la eficacia de ambas terapias es similar. Es preciso seguir realizando estudios comparativos para conocer mejor los mecanismos y establecer indicaciones prioritarias y comparar la relación coste-eficacia de ambos procedimientos (AU)

Introduction. Plasma exchange is a technique used in the treatment of some neurological autoimmune disorders since the 80s, especially in acute conditions. In recent years new data about it use has been published in many diseases with autoimmune basis, expanding the range of use of this technique. Aim. To update the current indications of this technique in the treatment of neurological diseases. Development. We conducted a thorough review of all articles about the efficacy of plasma exchange in the treatment of different neurological diseases published since the 80s. We have also carried out a detailed analysis of recommendations and evidence of the use of this procedure by analyzing the guidelines of different scientific societies. Conclusions. Plasma exchange has proven to be an effective alternative treatment with high grade scientific evidence in diseases such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy and myasthenia gravis. It has been effective in treating acute demyelinating episodes unresponsive to other therapies, neuromyelitis optica relapses and other central nervous system diseases induced by antibodies. In comparative studies with intravenous immunoglobulin efficacy of both therapies is similar. Comparative studies should continue to be conducted in order to better understand the mechanisms of action, prioritize indications and compare the cost-effectiveness ratio of both procedures (AU)

Postpartum plasma exchange in a woman with suspected thrombotic thrombocytopenic purpura (TTP) vs. hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP): a case study.

The occurrence of a hypercoagulable state and decreasing concentration of ADAMTS 13 in late pregnancy and during the postpartum period increases the risk for a woman to develop life-threatening thrombotic thrombocytopenic purpura (TTP). This is also the time of great risk for the more common obstetric complications of preeclampsia; eclampsia; and hemolysis, elevated liver functions tests, low platelets (HELLP) syndrome. These conditions are associated with high maternal and perinatal mortality. Differential diagnosis may be difficult due to the overlapping of clinical and laboratory findings, including thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, and renal insufficiency, making it difficult or impossible to distinguish them from TTP. Management of microangiopathic disorders encountered during pregnancy differ; therefore, an accurate diagnosis is required. Outcomes of TTP without plasma exchange therapy (TPE) are almost uniformly fatal. Early recognition and management of symptoms with prompt and aggressive TPE is essential when TTP is suspected.

Contraindication of angiotensin-converting enzyme (ACE) inhibitors for patients receiving therapeutic plasma exchanges.

Therapeutic plasma exchange is a therapy in which the plasma portion of the blood is removed by a device known as a cell separator. The separator works by spinning the blood at high speed to separate the cells from the fluid and returning the remaining cells to the patient, while the plasma is discarded and substituted with replacement fluids. Common complications of plasma exchange include the occurrence of hypotensive reactions. This article reviews the current literature in an attempt to clarify the correlation between the use of angiotensin-converting enzyme (ACE) inhibitors and hypotensive patient reactions, as well as examines the need for policy and guideline development regarding the combined therapies, and finishes by further examining future research implications.

Therapeutic plasma exchange.

The improvement in design and biocompatibility of continuous renal replacement therapy equipment has made it possible to perform therapeutic plasma exchange (TPE) in the intensive care unit. The purpose of this article is to outline the general principles of apheresis, including a historical perspective, current indications, and complications. Replacement fluid, membrane filtration, anticoagulation, and vascular access will be presented. A summary of the nursing care associated with TPE, potential complications, and methods to reduce the risk of their occurrence are summarized.

Physical assessment for patients receiving therapeutic plasma exchange.

As more nephrology programs include therapeutic plasma exchange (TPE), nephrology nurses must be prepared to treat the variety of indications for which TPE is prescribed. The purpose of this article is to assist nephrology nurses as they incorporate TPE into their scope of practice. The article addresses a total body systems approach to the physical assessment that is completed for all patients. Following the total physical assessment, specific areas of assessment are discussed as they relate to clinical diseases or syndromes for which TPE is the treatment of choice.

Technical considerations of therapeutic plasma exchange as a nephrology nursing procedure.

In the past, therapeutic plasma exchange (TPE) has had limited appreciation and lacked acceptance as a treatment modality. Jokingly, it has been referred to as a procedure looking for a disease because of seemingly broad historical applications to practice. In current clinical practice, TPE has earned its place as an aggressive therapeutic modality for treating a wide spectrum of diseases and/or syndromes. The acceptance of TPE has coincided with changes in equipment, technology, and the emergence of highly qualified professionals involved in performing the treatments. This article will describe these variables related to nephrology nurses becoming more involved in the use of TPE.

Familial hypercholesterolemia treated by plasma exchange and immunoadsorption.

IA clearly improved JL's HDL and LDL/HDL ratio because of its specificity, yet the extent of TC and LDL reduction per treatment was not as high as that obtained with TPE. Studies to achieve more efficient and specific extracorporeal lipid removal are in progress to help reduce the risk of CAD in FH patients and others. The continuity of procedural care and supportive needs provided by the nephrology nurses demonstrated a positive influence on J.L.'s acceptance of his familial genetic disorder and the prescribed chronic treatment regimen.