Manual plasmapheresis in the treatment of Guillain-Barré syndrome.

We report on 41 patients with Guillain-Barré Syndrome (GBS) with disability grade 4 and 5 who were treated with manual plasma exchange (PE). Approximately 20-40 ml/kg body weight of plasma was removed with each manual PE; 63% of patients needed one PE, 24% needed two, 10% needed three, and 2% needed four plasma exchanges. Normal saline, human serum albumin (NSA) and fresh frozen plasma were used in varying proportions as replacement solutions. Ninety-one percent of the patients resumed walking with very little assistance ranging from 4 to 56 days with an average of 25 days from the commencement of the first PE. Manual PE in our series was effective and safe as the reported experience of automated apheresis and less volume of plasma was exchanged in our patients undergoing manual PE when compared to those treated in other studies employing automated PE.