Safety of plasmapheresis in the treatment of neurological disease.

BACKGROUND: Plasmapheresis is used as a treatment modality in several neurological disorders. Adverse reactions relating to vascular access, replacement fluid and anticoagulant use have been reported. AIMS: To establish the incidence of complications of therapeutic plasmapheresis in the treatment of neurological diseases.
METHODS: A retrospective study was performed, in which case records of patients undergoing plasmapheresis for neurological indications between 1 April 1992 and 1 September 1996 were reviewed for fatalities and adverse reactions related to vascular access, transmission of Hepatitis B or C or Human Immunodeficiency Virus (HIV), fluid imbalance, allergic or febrile reactions, haematological complications, machine failure and citrate toxicity.
RESULTS: In the study period, 1283 plasmapheresis procedures were performed on 73 patients with neurological disease. There were no fatalities, no cases of Hepatitis B or C or HIV transmission, no allergic or febrile reactions, thrombosis, bleeding diathesis or severe citrate toxicity. Infections related to venous access occurred in 0.5 per cent of procedures with septicaemia in 0.2 per cent of procedures (4.1% of patients). Less serious complications included hypotension in 1.2 per cent of procedures (11% of patients) and citrate toxicity manifesting as nausea, vomiting, cramping or paraesthesia in 1.2 per cent of procedures. Machine failure occurred in 0.2 per cent of procedures.
CONCLUSIONS: Plasmapheresis is a safe procedure when performed for neurological indications by experienced personnel in a large pheresis unit. The most frequent adverse event is infection of the venous access site.