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A Retrospective study of complications of therapeutic plasma exchange in myasthenia

Authors

  • Jeffrey T. Guptill MD, MA,

    Corresponding author
    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
    • Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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  • Darlene Oakley RN,

    1. Duke Therapeutic Apheresis Service, Duke University Medical Center, Durham, North Carolina, USA
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  • Maragatha Kuchibhatla PhD,

    1. Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
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  • Amanda C. Guidon MD,

    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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  • Lisa D. Hobson-Webb MD,

    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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  • Janice M. Massey MD,

    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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  • Donald B. Sanders MD,

    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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  • Vern C. Juel MD

    1. Division of Neurology, Duke University Medical Center, DUMC 2900, Duke University Medical Center, Durham, North Carolina, 27710, USA
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Abstract

Introduction:

Venous access for therapeutic plasma exchange (TPE) in myasthenia gravis (MG) can be achieved by central venous catheters (CVC) or peripheral veins (PV), and the preferred method varies among providers. We evaluated our institutional experience with TPE venous access method and complications.

Methods:

We reviewed all TPE-treated MG patients (2005–2010) through blinded chart review. TPE complications were categorized as serious or minor. Serious complications ended the procedure and/or were potentially life-threatening.

Results:

A total of 134 MG patients received 230 TPE courses; 56% were outpatient procedures. Whenever feasible, TPE was performed by PV access, which was successful in 75% of courses. Over 90% in both groups improved after TPE. Compared with PV access, CVCs were associated with more total (68% vs. 35%) and serious complications (41% vs. 4%), including 2 deaths.

Conclusions:

PV access for TPE can be used successfully in most MG patients and may reduce morbidity of the procedure. Muscle Nerve, 2013

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