SAFETY OF PLASMAPHERESIS IN THE TREATMENT OF NEUROLOGICAL DISEASE

Background: Plasmapheresis is used as a treatment modality in several neurological disorders. Adverse reactions relating to vascular access, replacement fluid and anticoagulant use have been reported. Aims: To establish the incidence of complications of therapeutic plasmapheresis in the treatment of neurological diseases. Methods: A retrospective s tudy was performed, in which case records of patients undergoing plasm apheresis for neurological indications between 1 April 1992 and 1 Sept ember 1996 were reviewed for fatalities and adverse reactions related to vascular access, transmission of Hepatitis B or C or Human Immunode ficiency Virus (HIV), fluid imbalance, allergic or febrile reactions, haematological complications, machine failure and citrate toxicity. Re sults: In the study period, 1283 plasmapheresis procedures were perfor med on 73 patients with neurological disease. There were no fatalities , no cases of Hepatitis B or C or HIV transmission, no allergic or feb rile reactions, thrombosis, bleeding diathesis or severe citrate toxic ity. Infections related to venous access occurred in 0.5 per cent of p rocedures with septicaemia in 0.2 per cent of procedures (4.1% of pati ents). Less serious complications included hypotension in 1.2 per cent of procedures (11% of patients) and citrate toxicity manifesting as n ausea, vomiting, cramping or paraesthesia in 1.2 per cent of procedure s. Machine failure occurred in 0.2 per cent of procedures. Conclusions : Plasmapheresis is a safe procedure when performed for neurological i ndications by experienced personnel in a large pheresis unit. The most frequent adverse event is infection of the venous access site.