| Abstract | CILJEVI
Plazmafereza jedna je od najčešćih metoda afereze i njezina uporaba je u porastu. Ova studija ima za cilj opisati 13 godina iskustva u liječenju 250 bolesnika postupcima plazmafereze sa fokusom na promjene u indikacijama za postupak plazmafereze u ovisnosti o spolu, medicinskoj djelatnosti koja je indicirala postupak plazmafereze i u ovisnosti o bolesti koja je zahtijevala liječenje postupkom plazmafereze.
ISPITANICI I POSTUPCI
Studija je uključila 250 bolesnika koji su prošli postupak plazmafereze od 1. siječnja 2009. godine do 6. rujna 2021. godine. Ishodi studije su bili promjene u indikacijama za postupak plazmafereze koje su analizirane s obzirom na dijagnozu koja je zahtijevala postupak plazmafereze, medicinsko odjeljenje na kojem je bolesnik boravio tijekom hospitalizacije, specifična vremenska podrazdoblja ispitivanog perioda kao i s obzirom na spol bolesnika.
REZULTATI
Od 2009. do 2021. godine ukupno 250 bolesnika prošlo je 2082 postupka plazmafereze. Broj bolesnika liječenih plazmaferezom tijekom prvih deset godina ispitivanog razdoblja kretao se između 19 i 24, dok je broj postupaka tijekom ispitivanog perioda oscilirao između 104 (2018. godine) i 237 (2019. godine). Od svih uključenih bolesnika, 121 osoba je bila ženskog spola, dok su 129 osobe bile muškog. Od ukupno 43 dijagnoze koje su služile kao indikacija za postupak plazmafereze, tri najčešće dijagnoze su bile trombotska trombocitopenična purpura sa hemolitičko-uremičnim sindromom (574 postupka plazmafereze, 27.57% svih postupaka), Guillain-Barréov sindrom (572 postupka plazmafereze, 27.47% svih postupaka plazmafereze) i mijastenija gravis (340 postupaka plazmafereze, 16.33% svih postupaka plazmafereze). Broj pacijenata liječenih zbog mijastenije gravis oscilirao je između 13 (2016. godine) i 45 (2012. i 2013. godine), dok za Guillain-Barréov sindrom te trombotsku trombocitopeničnu purpuru sa hemolitičko-uremičnim sindromom isti podatak se kreće između 22 (2013. godine) i 82 (2019. godine) te 10 (2013. godine) i 109 (2016. godine). Prosječan broj postupaka plazmafereze indiciran po pojedinoj epizodi bolesti kretao se između 3.5 i 6 postupaka za mijasteniju gravis, 5 – 7 postupaka za Guillain-Barréov sindrom te 2 – 14.5 postupaka za trombotska trombocitopenična purpura s hemolitičko-uremičnim sindromom. Osim tri najčešće indikacije, postupci plazmafereze indicirani su za 40 drugih dijagnoza koje su indicirale ukupno 596 postupaka plazmafereze.
ZAKLJUČAK
Plazmafereza predstavlja učestali terapijski modalitet za liječenje određenih bolesti podjednako i kod muškaraca i kod žena bez značajnog trenda u promjenama najvažnijih indikacija za sam postupak. Ipak, s obzirom na raširenu uporabu postupka, potrebno je uložiti dodatan trud u pravilnu identifikaciju bolesnika i stanja koja su prikladna za liječenje ovim postupkom što bi trebalo biti temeljeno na najnovijim znanstvenim dokazima i dostupnim međunarodnim smjernicama. |
| Abstract (english) | OBJECTIVES:
Therapeutic plasma exchange is one of the most frequent apheresis techniques and its usage is increasing. This study aimed to describe 13 years of experience in treating 250 patients with TPE with a focus on the changes of indications for therapeutic plasma exchange according to gender, a medical specialty that indicated the therapeutic plasma exchange procedure, and according to the disease that required therapeutic plasma exchange treatment.
PATIENTS AND METHODS:
The study included 250 patients that underwent TPE from January 1st, 2009, to September 6th, 2021. Outcomes were changes in the indications for TPE procedures which were analyzed according to diagnosis that required therapeutic plasma exchange treatment, the medical department that the patient was hospitalized, specific subperiods of the study period, and according to the gender of the patients.
RESULTS:
From 2009 to 2021, in total 250 patients underwent 2082 plasmapheresis treatments. The number of patients treated with plasmapheresis during the first ten years of the study period was between 19 and 24, while the number of treatments during the study period oscillated between 104 (2018) and 237 (2019). Out of all included patients, 121 were female, and 129 were male. Out of 43 medical diagnoses that were indications for plasmapheresis, the three most common were Thrombotic Thrombocytopenic Purpura with the Hemolytic Uremic Syndrome (574 plasmapheresis treatments, 27.57% of all plasmapheresis treatments), Guillain-Barré syndrome (572 plasmapheresis treatments, 27.47% of all plasmapheresis treatments), and Myasthenia Gravis (340 plasmapheresis treatments, 16.33% of all plasmapheresis treatments). The average number of patients treated for Myasthenia Gravis oscillated between 13 (2016) and 45 (2012 and 2013), while the same number for Guillain-Barré syndrome and Thrombotic Thrombocytopenic Purpura with the Hemolytic Uremic Syndrome was between 22 (2013) and 82 (2019), and between 10 (2013) and 109 (2016), respectively. The average number of plasmapheresis treatments needed to treat a single episode of disease ranged from 3.5 to 6 treatments for Myasthenia Gravis, 5 - 7 treatments for Guillain-Barré syndrome, and 2 – 14.5 treatments for Thrombotic Thrombocytopenic Purpura with the Hemolytic Uremic Syndrome. Other than the three most common diagnoses, plasmapheresis was indicated for the treatment of 40 other medical diagnoses which resulted in 596 plasmapheresis treatments.
CONCLUSION
Plasmapheresis is a frequent therapeutical modality for treating certain conditions equally in both women and men without any significant changes in the most important indications. However, taking into account widespread use, additional efforts are needed to properly identify eligible patients and conditions for this treatment option which should be based upon the most recent scientific evidence and available international guidelines. |
