Buğra ÖZKAN, Hava ÜSKÜDAR TEKE, Döndü ÜSKÜDAR CANSU, Garip ŞAHİN

Terapötik Plazma Değişimi Endikasyonları, Komplikasyonları ve Yanıtları; Tek Merkez, Retrospektif Analiz Sonuçları

Terapötik plazma değişimi (TPD) plazmadan yüksek molekül ağırlıklı maddelerin uzaklaştırılmasını sağlayan bir işlemdir. Terapötik plazma değişimi işlemi iç hastalıkları pratiğinde birçok hastalıkta yaygın olarak kullanılmaktadır. Bu işlem ile ilgili son yıllarda farkındalığın ve ulaşılabilirliğin artmasına bağlı olarak güncel kılavuzlar yayımlanmaktadır. Bunlardan en genel geçer ve kapsamlı olanı Amerikan Aferez Cemiyeti (ASFA)’nin yayımladığı kılavuzdur. Bu çalışmada, iç hastalıkları kliniğinde herhangi bir nedenle terapötik plazma değişimi yapılan hastaların demografik verilerini, altta yatan hastalıklarını, biyokimyasal parametrelerini, replasman sıvısının volümü ve tipini, işlem sırasında ve sonrasında gelişen komplikasyonları, ek tedavileri, diyaliz ihtiyacı olup olmadığını, seans sayılarını retrospektif olarak belirleyerek klinik pratikte geliştirilebilecek yönleri ortaya koyabilmek amaçlandı. Çalışmada 2007 ve 2016 yılları arasındaki, 117 hasta retrospektif olarak değerlendirildi. Tüm olguların 63 (%53,8)’ü kadın, 54 (%46,2)’ü erkekti. Tanı anında hastaların yaş ortalaması 52,15 ± 16,8 (20-88) yıl idi. En sık TPD endikasyonu TTP ve ANCA ilişkili vaskülit idi. Taze donmuş plazma ve albümin en sık kullanılan replasman sıvılarıydı. Katater ilişkili komplikasyon oranı %5,1 idi. TPD süresince TPD ilişkili komplikasyon oranı %19,6 idi. TPD işlemi ile ilgili herhangi bir fatal reaksiyona rastlanılmadı. TTP tanılı hastaların başvuru anındaki laboratuvar verileri ile mortalite arasındaki ilişkiye bakıldığında ALP ve mortalite arasında anlamlı bir ilişki bulundu (p= 0.002). ANCA ilişkili vaskülit hastalarında ise klor ve hematokrit ile mortalite arasında anlamlı bir ilişki bulundu (sırasıyla p = 0.029, p= 0.037). Mortaliteyi tahmin etmede kullanım amacıyla, bu laboratuvar verilerinin teyidi için ileri çalışmalara ihtiyaç vardır. Sonuç olarak; TPD, çok az yan etki ile faydalı, kolay ve etkili bir hayat kurtaran tedavi yöntemidir.

Anahtar Kelimeler:

terapötik plazma değişimi, ttp, anca ilişkili vaskülit

Therapeutic Plasma Exchange Indications, Complications and Responses in Internal Medicine Patients: A Single Center, Retrospective Analysis

Therapeutic plasma exchange (TPE) is a process that allows high molecular weight substances to be removed from plasma. Therapeutic plasma exchange is widely used in many diseases in the practice of internal medicine. Current guidelines on this process have been published in recent years due to increased awareness and accessibility. The most common and most comprehensive of these is the American Apheresis Society (ASFA) guideline. In this study, we retrospectively determined the demographic data, underlying diseases, biochemical parameters, volume and type of replacement fluid, complications developed during and after the procedure, additional treatments, need for dialysis, and the number of sessions for patients who underwent therapeutic plasma exchange for any reason in the internal medicine clinic aimed to reveal aspects that can be improved in clinical practice. In the study, 117 patients between 2007 and 2016 were evaluated retrospectively. Of all cases, 63 (53.8%) were female. At the time of diagnosis, the mean age of the patients was 52.15 ± 16.8 (20-88) years. The most common indications for TPE were thrombotic thrombocytopenic purpura (TTP) and ANCA-associated vasculitis. Fresh frozen plasma and albumin were the most commonly used replacement fluids. Catheter related complication rate was 5.1%. The rate of complication related to TPE during TPE was 19.6%. No fatal reactions to TPE treatment were observed. There was a significant relationship between alkaline phosphatase (ALP) and mortality when the relationship between the laboratory data and the mortality rate of the patients with TTP was considered (p = 0.002). There was a significant correlation between chlorine and hematocrit and mortality in ANCA-associated vasculitis patients (p = 0.029 and p= 0.037, respectively). For the purpose of estimating mortality, further work is needed to confirm the validity of these laboratory data. As a result; TPE is a useful, easy and effective life saving treatment with few side effects.

Keywords:

therapeutic plasma exchange, ttp, anca-associated vasculitis,

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