Adaptive Therapeutic Plasma Exchange Technologies in Low-resource Settings: Utilization, Safety, and Clinical Insights from 2507 Neurological Cases

BACKGROUND: Therapeutic plasma exchange (TPE) is an established immunomodulatory therapy with proven efficacy in a wide range of neurological disorders. In recent years, expanding indications, combined with cost-effectiveness and a favorable safety profile, have increased their relevance, particularly in low-resource settings where access to intravenous immunoglobulin may be limited. This study analyzes our institutional experience with TPE in the management of diverse neurological conditions. MATERIALS AND METHODS: We conducted a retrospective observational study over a 5-year period (January 2015-December 2019) at the transfusion medicine department of a tertiary care neurological center. TPE was performed with a target plasma removal of 150-200 mL/kg body weight per session, using appropriate replacement fluids. Data regarding patient demographics, neurological indications, American Society for Apheresis indication categories, number of procedures, and procedure-related complications were analyzed. RESULTS: A total of 13,387 TPE procedures were performed in 2507 patients, with ages ranging from 9 to 86 years (mean age: 38.18 years). Guillain-Barré syndrome was the most common indication, accounting for 56.20% of cases, followed by other immune-mediated neurological disorders. Hypotension was the most frequently observed adverse event. Importantly, no procedure-related mortality was recorded during the study period. CONCLUSION: Therapeutic plasmapheresis is a safe, effective, and adaptable treatment modality for a broad spectrum of neurological disorders. Its favorable safety profile and clinical utility support its role as a valuable and sustainable therapeutic option, particularly in low-resource healthcare settings.