Pattern Of Symptomatic Recurrence In Myasthenia Gravis Patients Who Had Therapeutic Plasma Exchanges

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Pattern Of Symptomatic Recurrence In Myasthenia
Gravis Patients Who Had Therapeutic Plasma
Exchanges

• Ramakrishna L. Reddy, M.D
• Christina J. Burks, RN
• Kay L. Tafolla, RN
• Lynda M. Thoreen, RN

American Red Cross Midwest Region Blood
Services Mid American Division Omaha, NE
ASFA 4/9-12/2008 Galveston TX
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Introduction
ARC Midwest Region, Omaha, provides Therapeutic
Apheresis Services to all 11 metro area
hospitals. Annually, about 1000 procedures
including plasma exchange, RBC exchange, Platelet
and Leukocyte reduction, Photopheresis and
Cholesterol removal treatments and 600 peripheral
blood hematopoietic cell collections are
performed. The patients data is entered into our
Therapeutic Database. The diagnosis entered is
the diagnosis provided by the physician
requesting the procedure.
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American Red Cross Midwest Region Omaha, NE
ND
MN
WI
SD

IA

NE
Omaha
IL
CO
KS
MO
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Myasthenia Gravis (MG)

• Chronic disorder
• Prevalence 1 25,000
• Weakness and rapid fatigue of voluntary muscles
• Autoimmune etiology
• Acetylcholine receptor antibody
• Decreased number of acetylcholine receptors
• Management
• Acetylcholinesterase inhibitors- Pyridostigmine
  (Mestinon)
• Glucocorticoids
• Thymectomy
• Cytotoxic Therapies
• Therapeutic plasma exchange in myasthenic crisis

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MG Patient Data Review

• Data on patients who received TPE 1980 through
  2007 was reviewed
• Patients with a diagnosis of MG were identified
• TPE data on the MG patients analyzed

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MG Age Distribution

• 97 Patients 48 Males 49 Females
• Age range 15-85 years
• Years Number of Patients
• 11-20 3
• 21-30 12
• 31-40 8
• 41-50 4
• 51-60 9
• 61-70 17
• 71-80 28
• 81-90 4
• 4 males and 8 females age not recorded

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MG Patient TPE Procedure

• One plasma volume exchange
• Anticoagulant Citrate
• Replacement 5 Albumin FFP as needed based
  on fibrinogen level
• TPE on alternate day for 3 to 5 procedures
  considered one series
• Recurrence patient required TPE after first
  series
• Recurrence interval 1 month to 4 years
• All patients on various medical treatments, some
  had thymectomy

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MG Recurrence Requiring Repeat TPE

• Males Females
• 1 Series 58 30 26
• 2 Series 19 12 6
• 3 Series 8 5 3
• 4 Series 0 0
• 5 Series 2 0 2
• 6 or more series 13 1 12
• 7 patients with frequent recurrence received
  maintenance TPE weekly or bi-weekly. Responded
  with reduced frequency of recurrence or
  bi-weekly.
• One patient died while admitted for MG crisis

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Summary and Conclusions

• 45-53 of MG patients requiring TPE were in
  their 7th or 8th decade
• 58 of patients had one series of TPE
• 42 of patients had one or more recurrence
  requiring TPE
• 5 or more recurrences were seen mostly in female
  patients
• Some patients with frequent recurrence responded
  well with weekly or bi-weekly maintenance TPE and
  could avoid hospital admission for MG crisis

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My thanks are due to the physicians who referred
patients for therapeutic procedures and to our
Apheresis staff who were ready to perform
procedures at anytime.
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Thank You. Questions?