Terapötik Plazma Değişiminin Romatolojik Hastalıkların Tedavisindeki Önemi
Özet
Therapeutic Plasma Exchange (TPE) is an effective therapeutic option for treating serious manifestations of systemic autoimmune diseases. This study is aimed to investigate the main demographic and clinical characteristics as well as the outcome of patients with systemic autoimmune diseases treated with TPE at an university hospital. Patients treated with TPE between 2002-2013 were included into the study. Indications for TPE, complications and outcomes were obtained from hospital records. A total of 60 patients (female/male: 43/17) were treated with TPE. Mean age at the time of TPE is 37,0±16,5 (range: 15-73 years). Twentyone (35.0%) patients had SLE, 14 (23.4%) patients had vasculitis, 6 (%10) patients had Sjogren syndrome, 4 (%6,7) patients had dermato/polimyositis, 3 (%5,0) patients had primary antiphospholipide syndrome, 12 patients with other diagnoses. Indications for TPE were hematologic (28.4%), neurologic (28.3%), pulmonary (20.0%) and renal failure (23.4%), myopathy (5.0%), hepatic (5.0%) and dermatologic (3.4%) causes. In 9 (15%) of patients TPE had performed in case of concomitant leucopenia or infection. Fifteen of the patients (25%) had TPE required disease involvement as presenting feature. All patients were receiving corticosteroids at varying doses and all received a concomitant immunosuppressive drug. Outcome analysis had been done in 55 (91.6%) of patients. Totally 20 (33.3%) of patients had been died (17 of them during first treatment course, 3 of them after discharge from hospital). More than half of the patients with pulmonary (57.9%) and renal (63.6%) cause as TPE indication had been died whereas in neurologic and hematologic causes mortality were lower (26.7% and 18.8%, respectively). Demographic and clinical characteristics of mortality and survival patients compared. There were no significant differences in terms of age and cardiovascular risk factors. Hemoglobin and albumin levels after TPE were lower, but creatinine and proteinuria were higher in mortality patients. The median count of TPE sessions were 6 (range 2-33) per patient. In 32.3% of patients TPE had been performed in more than 10 times. Major adverse events of TPE occurred in 14 (23.3%) of patients (catheter related problems in 6 patients, hypotension in 3 patients, 1 catheter infection, 2 thrombocytopenia and hypocalcemia in 1 patient). One patient died due to atrial fibrillation and myocardial infarction during periprocedural period. İn conclusion, TPE is an effective therapeutic option for treating serious manifestations of systemic autoimmune diseases with few adverse events. TPE could be a valid option for those with refractory disease to conventional treatments and concomitant infection and/or leucopenia. Patients with pulmonary and renal indications had increased mortality compared to patients with hematologic and neurologic indications.