Physiological changes during and outcome following ‘filtration’ based continuous plasma exchange in Guillain Barre Syndrome

Jayasena, Yatagama Arachchige A.; Mudalige, Shalika P.; Manchanayake, Geethika S.M.; Dharmapala, Hikkaduwe Liyanage P.S.; Kumarasiri, Ranjith P.V.; Weerasinghe, Vajira S.; Goonasekera, Chulananda D.A.

doi:10.1016/j.transci.2010.01.002

« Previous Next »Transfusion and Apheresis Science
Volume 42, Issue 2 , Pages 109-113, April 2010

Physiological changes during and outcome following ‘filtration’ based continuous plasma exchange in Guillain Barre Syndrome

Yatagama Arachchige A. Jayasena
- Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
Shalika P. Mudalige
- Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
Geethika S.M. Manchanayake
- Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
Hikkaduwe Liyanage P.S. Dharmapala
- Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
Ranjith P.V. Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
Vajira S. Weerasinghe
- Department of Physiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
Chulananda D.A. Goonasekera
- Department of Anaesthesiology, Faculty of Medicine, University of Peradeniya, Sri Lanka
- Corresponding author. Tel.: +94 712771507; fax: +94 812 387394.

Abstract

Background

Therapeutic plasma exchange is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from plasma. It is the first line treatment in Guillain Barre Syndrome (GBS) improving outcome.

Aim

To study the outcome in GBS following therapeutic plasma exchange (TPE) utilizing a modified, cost saving, filtration based plasma exchange technique.

Methodology and findings

Consenting patients with GBS underwent TPE using a modified regime of two 48h sessions as a cost saving strategy. The second session was conducted only if there was inadequate benefit from the first session. Nerve conduction studies confirmed the diagnosis of GBS.

Results

Fifteen patients were studied. One died following a cerebro-vascular accident. Of the remaining 14 patients, five showed improvement in muscle power at least by one grade in one limb within 48h of plasma exchange. The duration of intensive care unit stay was 10 (median) days (range 4–66). Nine required mechanical ventilation for (median) 15days (range 4–50). The mean 24h urine output increased significantly since the initiation of plasma exchange was 6262.92ml (SD=8867.24, P=0.032) at 48h and 6474.92ml at 72h (SD=6364.81, P=0.003). The pulse rates and blood pressures were not significantly different before and after plasma exchange. Complications attributable to plasma exchange were mild; a hypersensitivity reaction and a tendency to ooze from a puncture site.

Conclusion

‘Continuous’ TPE, the modified cost saving technique seems to improve the outcome of patients with Guillain Barre Syndrome with minimal complications.

Keywords: Guillain Barre Syndrome, Plasmapheresis, Polyuria, PRISMA machine, Outcome