Prospective Evaluation of Critically İll Patients with Therapeutic Plasma Exchange in Medical İntensive Care Unit

Abstract

Aim: Therapeutic plasma exchange (TPD) is the separation of the patient's plasma for treatment purposes and the replacement of another fluid. Therapeutic plasma exchange, the use of which has expanded in recent years, is a treatment method that cleans the blood extra-corporeally and is used in many immunological and toxicological diseases. The aim of this study is to prospectively examine critical patients who are followed up in the intensive care unit and undergo therapeutic plasma exchange. Material and Method: Patients who were hospitalized in the Intensive Care Unit of Erciyes University, Faculty of Medicine, older than 18, and whose therapeutic plasma exchange (TPD) indication were included in the study. Demographic information of the patients, indication for admission to intensive care unit, and TPD indication were recorded before the procedure. Patients who were indicated for plasmapheresis were observed for side effects during the procedure. Results: A total of 31 patients were included in the study. The mean age of the patients was 46 ± 18 years. 52% of the patients were female and 48% were male. The hospitalization medyan APACHE II score (min-max: 5-40) of the patients was 20. When the patients were evaluated in terms of TPD indications in intensive care, the most common causes were 56% microangiopathic hemolytic anemia (MAHA), 13% Crimean Congo Hemorrhagic Fever (KKKA) and 10% Guillen Barre Syndrome. The patients were divided into two groups: living and dying. When these two groups were analyzed in terms of APACHE II Score, the mean APACHE II score of living patients was 17±7, and the mean APACHE II score of the patients who died was 25 ± 9. This difference was statistically significant (p = 0.02). The median day of the patients staying in intensive care unit was 12 (min-max: 1-86), and intensive care mortality was 48%. Conclusion: The frequency of TPD indications of patients included in the study is compatible with the literature, and TPD was applied most frequently because of MAHA. The patients were younger than the normal intensive care population. This study provides clinicians with some helpful information about the intensive care clinical course before patients undergo TPD.