Dept of Transfusion Medicine, Post Graduate Institute of Education and Research (PGIMER) Chandigarh India SAS NAGAR, Punjab, India
Background/Case Studies: Therapeutic plasma exchange (TPE) is a technique of removal of desired/pathogenic blood components from the patient for therapeutic purposes with or without the use of replacement fluids. Two methods are used in the TPE: centrifugal TPE (cTPE) based on specific gravity and membrane TPE (mTPE), based on molecular size. A head-to-head comparison between the two technologies was made to find the which technology has more effective plasma removal efficacy, has more improvement in patient morbidity and outcomes, has less adverse effects and is a more cost-effective modality in a developing world with resource-constrained setting like ours.
However, in India the comparison studies between the two technologies of plasma exchange i.e. centrifugal and membrane plasma exchanges are lacking. This brings up the question of effectiveness and safety of both these procedures, in removal of various biochemical and pathological substances.
Study
Design/Methods: A prospective, open-labelled randomised controlled trial was conducted at the a tertiary care institute of Northern India from June 2022 to April 2023 after obtaining approval by the Institute Ethics Committee. A total of 122 TPE procedures were performed on 18 patients and data was recorded for the TPE procedures, such as procedure time, plasma removal efficiency (PRE), and removal efficiency of haematological and biochemical parameters evaluated, adverse effects if any during the procedures as well as outcomes at 30 and 90 days. The Spectra Optia device (Terumo, Lakewood, Colorado, USA) was used for cTPE and Octonova device (Diamed, Cologne, Germany) with P2 dry filter (Fresenius Medical Care Deutschland; Germany) was used for the mTPE procedure.
Results/Findings: Although both procedures removed similar amounts of plasma, the total time on mTPE device is mean ± SD (124.3 ± 8.9) came to be less compared to cTPE (147.7 ± 34.1; p = 0.064). The difference in PRE between the cTPE (67.2%) and the mTPE (29.6% ; p < 0.001) was significant. The cost analysis of cTPE and mTPE was done. The overall cost of one cTPE procedure was INR 13,489 which is 55.5% higher than the cost of one mTPE procedure which is INR 7,475.
Conclusions: Our findings suggest that plasma removal efficiency rates were significantly better in cTPE compared to mTPE procedures with lesser blood volumes processed. In view of mTPE procedure having lesser plasma removal efficiency, multiple mTPE procedures were required to achieve the same plasma removal efficiency which can be achieved by a single cTPE procedure. The cost of cTPE is comparable to mTPE for similar PRE, so it seems like a better therapeutic modality. Therefore, cTPE may be considered a first choice than mTPE. However, larger clinical trials would be required with a larger sample size to substantiate these findings.
