Plasmapheresis for Neuromyelitis Optica: A Review from the Transfusion Medicine Specialist’s Perspective

Neuromyelitis optica is characterised by severe visual impairment and neurologic dysfunction, and aggressive plasmapheresis treatment is often recommended. Medication and therapeutic interventions for acute and chronic treatment have been the subject of retrospective studies and case reports; however, the clinical improvement that follows plasmapheresis cannot be explained merely by the removal of the pathogenic antibodies. The guidelines regarding plasma volume in plasmapheresis are often not adhered to; however, treatment of lesser volume reduces complications and the cost incurred, without affecting clinical outcome. The goal of this review is to understand the biologic and clinical data supporting plasmapheresis, examine the possible role of low-volume plasma treatment, and highlight advanced apheresis techniques that may be applied as therapeutic modalities

Treatment-related fluctuations in guillain barre syndrome and the conundrum of additional cycles of plasmapheresis

Introduction: In Guillain Barre syndrome (GBS), worsening of weakness or disability after initial period of recovery or stabilization is described as treatment-related fluctuations (TRF). Aim: This study aims to describe the clinical characteristics and outcome of six patients with GBS and TRF. Patients and Methods: Six patients with GBS fulfilling NINCDS criteria, evaluated at a tertiary care university hospital during 2008–2017, were diagnosed to have TRF. They form the basis of this report. Results: All patients were men and their mean age was 40 years. At presentation, mean duration of illness was 15 days; the illness had plateaued in three and progressive in other three patients. Two of the four patients had variant GBS. Initially, five patients were treated with large volume plasmapheresis (LVPP) and one patient with methyl prednisolone. At 17–28 days after disease onset, three patients developed new neurologic deficits (bilateral facial paresis in two; paralytic ileus in one). Other three patients with worsening of limb weakness (medical research council sum score of >5) and disability (Hughes disability grade by ≥1) fulfilled Kleyweg's criteria for TRF. All the six patients were treated with the completion of five cycles or additional cycles of LVPP. Conclusion: Awareness about TRF is essential for correct diagnosis and management of patients with GBS