Therapeutic Plasma Exchange: Analysis of Practices and Compliance With International Guidelines

Therapeutic plasma exchange (TPE) is widely used in the treatment of autoimmune diseases and hematological emergencies. It is also applied in transplant patients for the desensitization of anti-HLA (human leukocyte antigen) antibodies and the management of antibody-mediated rejection. This study aims to assess the epidemiology of therapeutic plasmapheresis and evaluate whether indications for plasmapheresis align with the guidelines of the American Society for Apheresis (ASFA) and investigate the associated adverse effects. This retrospective observational study was conducted in hospitals in Belo Horizonte, Minas Gerais, and included 85 patients who underwent 493 TPE sessions between April 2021 and December 2023. The median age was 43 years, and 60% of the patients were women. The most common indications for TPE were neuromyelitis optica (24%) and acute rejection following kidney transplantation (21%). The replacement fluids used were primarily albumin (84%) and plasma frozen 24 h after phlebotomy (16%). Adverse events were reported in 5.88% of patients, including hypotension, vasovagal reflex, and one case of facial edema and urticaria. No procedure-related deaths were observed. TPE sessions were conducted in accordance with the guidelines of the ASFA, with 50% of procedures classified as Category I. There was no significant association between adverse events and patient diagnoses. The study demonstrated that TPE is effective and safe, with predominant indications for neuromyelitis optica and kidney transplant rejection, following ASFA guidelines. Adverse events were rare and manageable.