Anju Joy, Brilsee Simeon
1. Assistant Professor, Department of Immunohaematology and Blood Transfusion, Esic Mc Pgimsr, Rajaji Nagar, Bangalore, Karanataka, India.
2. Associate Professor, Department of Immunohaematology and Blood Transfusion, Esic Mc Pgimsr, Rajaji Nagar, Bangalore, Karnataka, India.
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: Therapeutic Plasma Exchange (TPE) is a cornerstone treatment for Guillain-Barré Syndrome (GBS). Two commonly employed modalities include centrifugation-based TPE (cTPE) and membrane filtration-based TPE (mTPE); however, comparative data on their clinical outcomes, procedural characteristics and safety in low-resource settings remain limited.
Aim: To compare the clinical effectiveness, safety and procedural differences between centrifugation and filtration-based TPE in patients with GBS.
Materials and Methods: A cross-sectional analytical study was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India over a 16-month period from January 2021 to April 2022. A total of 36 GBS patients were included: 19 treated with cTPE in the Department of Transfusion Medicine and 17 with mTPE in the Department of Nephrology. Procedural parameters such as the type of TPE machine, anticoagulant used, Total Blood Volume (TBV) processed, Total Plasma Volume (TPV) exchanged, volume of replacement fluid infused, total procedure time, cost, laboratory changes, adverse events and clinical outcomes were compared between the groups.For statistical analysis, the Ranksum test (Mann-Whitney U test) was used to compare procedural details between departments, including median plasma volume, cost incurred (covering vascular access, procedure kit and tubing, anticoagulant, replacement fluid and calcium gluconate injections) and duration of the procedure. The unpaired t-test was used to assess differences in laboratory parameters and clinical parameters {Glasgow Coma Scale (GCS), power} both pre- and post-plasma exchange between the two departments
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Results: The mean age of participants was 48±15 years, with a male predominance of 21 (58.3%). Blood group A+ was the most common, occurring in 15 (41.7%) patients. All patients underwent five sessions of plasma exchange. Centrifugation TPE was associated with a higher mean plasma volume processed of 2316 mL, whereas during filtration plasma exchange, the volume processed was 1980 mL. The cumulative procedure duration for centrifugation TPE was longer at 243 minutes compared to 150 minutes during filtration TPE. There were greater reductions in platelet count of 39% for centrifugation TPE versus 30% for filtration TPE and a more pronounced drop in haemoglobin of 10% for centrifugation TPE versus 5.5% for filtration TPE. Allergic reactions such as itching, hypotension and redness were more frequent in the cTPE group, whereas infections (fever, chills, rigours) were more common with mTPE. Specifically, in the nephrology (mTPE) group, allergic reactions accounted for 57.1% (4) of all adverse events and infections for 42.9% (3). In contrast, in the cTPE group, allergic reactions accounted for 87.5% (7) and infections only 12.5% (1) of the reported events. However, the overall adverse event rates between the two groups were not significantly different.
Conclusion: Both centrifugation and filtration-based TPE are effective in treating GBS, but they differ in cost, procedure duration and safety profiles. In resource-limited settings, mTPE may be preferred due to lower costs and shorter durations, provided that infection control is adequate. cTPE offers advantages in plasma volume processing and adherence to full cycle completion. Modality selection should be individualised based on clinical stability, institutional logistics and patient-specific considerations. Multicentre Randomised Controlled Trials (RCTs) are needed to validate these findings and standardise treatment protocols. |
