A study on therapeutic plasma exchange using apheresis in treatment of Guillain-Barré syndrome in a tertiary care teaching hospital

S. Subash, D. Umesh, Prathyusha Mervala


Background: Therapeutic plasma exchange (TPE) is the separation and removal of plasma from whole blood with replacement by a crystalloid/colloid solution (typically albumin or plasma). The DGHS has established guidelines and recommendations for application of therapeutic apheresis in clinical practice. Guillain-Barré syndrome (GBS) is considered category I indications for TPE. This study was undertaken to establish the effectiveness and safety of therapeutic plasma exchange in GBS which is one of the common indication for TPE at our tertiary care teaching hospital.

Methods: A retrospective study of 30 patients admitted to a tertiary care teaching hospital, from January 2014 to December 2016 with clinical signs of Guillain-Barre syndrome (GBS) and/or GBS variants were evaluated for performing TPE. A total of 104 procedures were performed for 30 patients. Replacement of crystalloids and plasma was used. Medical Research Council scale was used to assess the clinical improvement by measuring the grade of muscle power. Information was collected in a structured proforma and statistical analysis was performed using SPSS software (version 20). P value less than 0.05 was considered statistically significant.

Results: During the study period, 104 procedures were performed on 30 patients on an average of three procedures per patient. The average age of the patients was 41.4±10.4 years. The mean period of illness at admission was 14.5±5.4 (range 4-32) days. In 23 out of 30 patients, more than three TPE procedures were done, out of which 21 patients clinically improved. The common complications during the procedure were chills (16%), hypotension (10%) and non-hemolytic febrile transfusion reaction (10%) and they were managed accordingly. Two (6.7%) patients who were not ambulatory at discharge had significantly (p <0.05) lower grade of power in lower limbs at admission and all patients recovered fully on follow up.

Conclusions: GBS is one of the most commonly occurring clinical paralytic disorders. 76.7% of patients underwent three or more cycles of TPE with 70% had excellent clinical improvement which was comparable with various other studies. Based on results published by various other studies, therapeutic plasma exchange is a comparatively safe and effective procedure.


Guillain–Barré syndrome (GBS), Medical Research Council Scale, Therapeutic plasma exchange (TPE)

Full Text:



Directorate General of Health Services, Transfusion Medicine Technical Manual, 2nd edition. Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi; 2003:242-243.

Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2010;25:83-177.

Tobian AAR, Shirey RS, Montgomery RA, Tisch DJ, Ness PM, King KE. Therapeutic plasma exchange reduces ABO titers to permit ABO incompatible renal transplantation. Transfusion 2009;49:1248-54.

Norda R, Berseus O, Stegmayr B. Adverse events and problems in therapeutic hemapheresis. A report from the Swedish registry. Transfus Apher Sci. 2001;25:33-41.

McLeod BC, Sniecinski I, Ciavarella D. Frequency of immediate adverse effects associated with therapeutic apheresis. Transfusion. 1999;39:282-8.

Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012;45:18-25.

Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978;2:750-3.

Yuki N, Hartung HP. Guillain-Barré syndrome. N Engl J Med. 2012;366:2294-304.

Hughes RA, Wijdicks EF, Barohn R, Benson E, Cornblath DR, Hahn AF, et al. Practice parameter: immunotherapy for Guillain-Barré syndrome: Report of the quality standards subcommittee of the American Academy of Neurology. Neurol. 2003;61:736-40.

Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z. Complications of therapeutic plasma exchange: Experience with 4857 treatments. Ther Apher Dial. 2005;9:391-5.

Kishore CK, Vijayabhaskar J, Vardhan VR, Sainaresh VV, Sriramnaveen P, Sridhar AV, et al. Management of Guillain-Barré syndrome with plasmapheresis or immunoglobulin: our experience from a tertiary care institute in South India. Ren Fail. 2014;36:732-6.

Basic-Jukic N, Kes P, Glavas-Boras S, Brunetta B, Bubic-Filipi L, Puretic Z. Complications of therapeutic plasma exchange: experience with 4857 treatments. Ther Apher Dial. 2005;9:391-5.