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TPE for Guillain-Barré Syndrome

FOR HEALTHCARE PROFESSIONALS

Plasma exchange as first-line therapy

The Spectra Optia™ Apheresis System is a therapeutic apheresis system indicated to treat Guillain-Barré syndrome (GBS). Plasma exchange is recommended as a first-line therapy.

When GBS is progressing quickly, a decisive first response is critical. The longer treatment is delayed, the less likely it is that a patient will achieve optimal results.

Studies show that GBS patients who receive plasma exchange therapy experience faster response and recovery compared to those receiving only supportive care.¹˒²

Results of plasma exchange for GBS¹

  • One or more disability-grade improvements after 4 weeks
  • Decreased ventilator dependency after 4 weeks
  • Improved functional abilities (for example, faster time to unaided walking and significantly improved grip strength 4 weeks after first plasma exchange)
  • Increased probability of full muscle strength recovery and decreased probability of severe sequelae at 1 year

Evidence-based guidelines for plasma exchange in GBS

American Academy of Neurology (AAN)3

  • Severe GBS — Class I, Level A
  • Mild GBS — Class I, Level B

American Society for Apheresis (ASFA) 2016⁴

  • Category I, Grade 1A
  • Category III, Grade 2C

European Federation of Neurological Societies (EFNS) 2008⁵

  • Level A

Cochrane Neuromuscular Disease Group1

  • Severe GBS — Class I, Level A
  • Mild GBS — Class I, Level B

Contraindications
Leukocytapheresis is contraindicated in acute myeloid leukemia FAB M3 (acute promyelocytic leukemia) because of the accompanying disseminated intravascular coagulation.6,7 Other contraindications for the use of the Spectra Optia system are limited to those associated with the infusion of solutions and replacement fluids as required by the apheresis procedure and those associated with all types of automated apheresis systems.

Adverse events of apheresis procedures can include
Anxiety, headache, light-headedness, digital and/or facial paresthesia, fever, chills, hematoma, hyperventilation, nausea and vomiting, syncope (fainting), urticaria, hypotension, allergic reactions, infection, hemolysis, thrombosis in patient and device, hypocalcemia, hypokalemia, thrombocytopenia, hypoalbuminemia, anemia, coagulopathy, fatigue, hypomagnesemia, hypogammaglobulinemia, adverse tissue reaction, device failure/disposable set failure, air embolism, blood loss/anemia, electrical shock, fluid imbalance, and inadequate separation of blood components.

Reactions to blood products transfused during procedures can include
Hemolytic transfusion reaction, immune-mediated platelet destruction, fever, allergic reactions, anaphylaxis, transfusion-related acute lung injury (TRALI), alloimmunization, posttransfusion purpura (PTP), transfusion-associated graft-versus-host disease (TA-GVHD), circulatory overload, hypothermia, metabolic complications, and transmission of infectious diseases and bacteria.8,9

Restricted to prescription use only

  • Operators must be familiar with the system's operating instructions.
  • Procedures must be performed by qualified medical personnel.

Disclaimers and notes

  1. Chevret S, Hughes RAC, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2017;2:CD001798.
  2. Hund EF, Borel CO, Cornblath DR, Hanley DF, McKhann GM. Intensive management and treatment of severe Guillain-Barre syndrome. Crit Care Med. 1993;21(3):443-446.
  3. Cortese I, Chaudhry V, Yuen T, et al. Evidence-based guideline update: Plasmapheresis in neurologic disorders. Neurology. 2011;76(3):294-300.
  4. Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice—Evidence-based approach from the writing committee of the American Society for Apheresis: The seventh special issue. J Clin Apher. 2016;31(3):149-162.
  5. Elovaara I, Apostolski S, van Doorn P, et al. EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases. Eur J Neurol. 2008;15(9):893-908. Corrigendum 2009;16(4):547.
  6. Vahdat L, Maslak P, Miller WH Jr, et al. Early mortality and the retinoic acid syndrome in acute promyelocytic leukemia: impact of leukocytosis, low-dose chemotherapy, PMN/RAR-alpha isoform and CD13 expression in patients treated with all-trans retinoic acid. Blood. 1994;84(11):3843-3849.
  7. Daver N, Kantarjian H, Marcucci G, et al. Clinical characteristics and outcomes in patients with acute promyelotic leukaemia and hyperleucocytosis. Br J Haematol. 2015;168(5):646-653.
  8. AABB. Circular of Information for the Use of Human Blood and Blood Components. Bethesda, MD: AABB; 2017.
  9. European Directorate for the Quality of Medicines & HealthCare (EDQM). Guide to the Preparation, Use and Quality Assurance of Blood Components. 19th edition. Strasbourg, France: EDQM Council of Europe; 2017.
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