uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Recognition of inter-center differences may help develop best practice: Analysis of data from the Swedish Apheresis Registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Clinical Immunology.
Show others and affiliations
2008 (English)In: Therapeutic apheresis and dialysis, ISSN 1744-9979, Vol. 12, no 5, 347-354 p.Article in journal (Refereed) Published
Abstract [en]

The Swedish Apheresis Registry is a National Quality Registry and performing intercenter comparisons can be done as one task. The purpose of this study was to evaluate differences in adverse effects (AE) associated with plasma exchange (PE) for the development of best practice. Six hundred and twenty reports of AE related to a total of 12 461 apheresis procedures performed during 1996-2002 were analyzed, and eight Swedish university hospital centers that reported AE every year were compared. About 70% of all PE in Sweden were performed in centers that also reported AE. During this period, there was no change in the proportion of PE procedures with AE, but there was a decrease in the frequency of prematurely interrupted procedures (2.1% to 1.3%, P=0.003). The mean frequency of moderate and severe AE was 5%. Adverse effects were more common when PE was performed in patients with Guillain-Barrel syndrome (GBS; 10%) or thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS; 8%) than in patients with macroglobulinemia/hyperviscosity syndromes (2%). In the eight centers, there was a four-fold difference in AE between the centers with the highest and the lowest frequency. The frequency of AE in GBS, TTP-HUS and macroglobulinemia/hyperviscosity syndromes differed four-fold, while the frequency of specified symptoms differed more than four-fold. The indications and the choice of substitution fluids could explain some of these differences. The results of the study have initiated changes in practice. The identification of significant intercenter differences in the frequency and symptoms of AE has started improvement in current PE practices.

Place, publisher, year, edition, pages
2008. Vol. 12, no 5, 347-354 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-95817DOI: 10.1111/j.1744-9987.2008.00608.xISI: 000263223400002OAI: oai:DiVA.org:uu-95817DiVA: diva2:170163
Group Author(s): Swedish Apheresis GrpAvailable from: 2007-04-19 Created: 2007-04-19 Last updated: 2011-04-25Bibliographically approved
In thesis
1. Plasma as a Therapeutic Principle in Clinical Practice: With Special Reference to Sweden
Open this publication in new window or tab >>Plasma as a Therapeutic Principle in Clinical Practice: With Special Reference to Sweden
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The newly established Swedish Apheresis Registry makes it possible to do national inter-center comparisons. This study was undertaken to describe and analyze the use of therapeutic apheresis and the adverse effects in such therapy. The special case of plasma exchange as rescue therapy in multi-organ failure, including renal failure, was also studied. In Sweden, plasma for transfusion is prepared and stored to ensure rapid availability. Due to new EU legislation, validation of such plasma was performed.

The analysis indicated that the use of therapeutic apheresis was in line with recommendations of other international societies. The frequency and types of adverse effects were comparable to those reported in other studies from analogous time periods. Compared with other countries, it appears that more therapeutic resources are available in Sweden and that there is a lower frequency of adverse effects in specific procedures. No fatalities were reported. The unique comparison of differences between centers regarding plasma exchange identified areas for further improvement.

The study on plasma exchange as rescue therapy in severe sepsis or septic shock is the second largest reported. The result was promising, with a survival rate of 82%. The rapid availability of plasma for transfusion appears to be of clinical importance in patients with early coagulopathy and severe trauma but the present selection and storage procedures for plasma lead to a time-dependent increase of the number of units with cold-induced activation of the contact system and C1 inhibitor consumption before day 14. Improvements of plasma quality can be attained by using plasma from male donors only and by reducing the storage time from 14 to 7 days.

Further studies are needed to define the role of plasma exchange in severe sepsis/septic shock, to evaluate the outcome of each patient’s treatment and to establish the indications for the transfusion of plasma.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 69 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 255
Immunology, adverse effects, contact activation, plasma exchange, plasma storage, severe sepsis, therapeutic apheresis, transfusion, Immunologi
urn:nbn:se:uu:diva-7838 (URN)978-91-554-6877-4 (ISBN)
Public defence
2007-05-10, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15
Available from: 2007-04-19 Created: 2007-04-19Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text
By organisation
Clinical ImmunologyDepartment of Medical Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 201 hits
ReferencesLink to record
Permanent link

Direct link