CASES OF THE WEEK - “First Plasma Exchange procedure in Al Zahra Hospital Sharjah” by Dr Aditya Bhabhe, Specialist, Consultant Nephrology, NMC Hospital Sharjah

Report of first procedure of Plasma Exchange in Al Zahra Hospital Sharjah

We are happy to report that we performed the procedure of Plasma Exchange for the first time in AZHS.

It is the standard of care for many critical diseases.

Brief clinical course of the patient:

Patient was under the care of Dr Mohamed Azzam Ziade, Consultant Oncology & Hematology. Patient had refractory thrombocytopenia with features of hemolysis (Schisctocytes in peripheral blood; elevated LDH and anemia). Patient also had altered neurological status and fever.

A diagnosis of TTP (Thrombotic Thrombocytpenic Purpura) was made.

As a part of the standard of care we performed 5 sessions of plasmapheresis in this patient. There was improvement in the laboratory parameters indicative of recovery from TTP.

The procedure was done in the ICU for 5 sessions using the dialysis machines. The patient tolerated the sessions well with no major adverse reactions.

Plasma Exchange : some details

# What is plasma exchange: Therapeutic plasma exchange (TPE), also called plasma exchange or therapeutic plasmapheresis, involves removal of patient plasma and replacement with another fluid (eg, allogeneic donor plasma, colloid, crystalloid).

# What is the principle of plasma exchange: Removal of certain pathologic substances from the plasma which will reduce further damage and may permit reversal of the pathologic process. The pathologic substance may be an autoantibody, immune complex, cryoglobulin, myeloma light chains or  cholesterol-containing lipoprotein.

Indications in which we can perform plasma exchange:

1. GBS (Guillain–Barré Syndrome)
2. CIDP (Chronic Inflammatory-Demyelinating Polyneuropathy)
3. Myasthenia gravis crisis
4. TTP (Thrombotic Thrombocytpenic Purpura) / HUS (Hemolytic Uremic Syndrome)
5. ANCA associated vasculitis
6. Anti-glomerular basement membrane disease (Goodpasture’s syndrome)
7. Refractory multiple myeloma with renal failure

Specialties which can utilize this expertise:

We now have the clinical expertise to perform this procedure in our ICU and request all doctors who have suitable patients for the same to utilize this facility.

The following specialties may have the most patients for this:

1. Hematology and Oncology
2. Internal Medicine
3. Critical care/ ICU team
4. Pediatrics
5. Neurology
6. Rheumatology

I thank Dr Mohamed Azzam Ziade, our dialysis team and ICU team for providing all the necessary support to perform this procedure.