Trend of indications for therapeutic plasma exchange at an Iranian university hospital

Background: There is neither a registry system nor center-by-center reports on therapeutic plasma exchange in Iran. We evaluated the trend of indications as well as techniques and safety of plasma exchange in a single center in Iran. Methods: All registered cases in the plasma exchange unit of Al-Zahra hospital between 1996 and 2005 accounting for 560 patients (260 men, 300 women; median age 29, range 1–95 years) who underwent a total of 3985 procedures were included. Data collection was performed using the official questionnaire of the International Apheresis Registry System. Results: The total number of procedures per year has remained stable corresponding to a median of 9 treatments per 100,000 inhabitants. Of the 560 patients, the majority had neurologic (62.8%), followed by hematologic disorders (16.9%). The three most common indications were: Guillain–Barré syndrome (27.8%), myasthenia gravis (23.0%) and thrombotic thrombocytopenic purpura (11.4%). Three hundred and seventy-nine patients (67.7%) belonged to category I of the ASFA indication classification, 28 (5%) to category II, 104 (18.5%) to category III, and five (0.9%) to category IV. Forty-four cases (7.8%) were unclassified. All plasma exchanges were performed with a discontinuous flow centrifugation method. Normal saline + albumin (5%) was the main liquid of replacement (77.9%). Conclusion: The trend of indications in our center is comparable to international data. However, the average number of procedures in our population is lower than world statistics and the method of plasma exchange has not been modified.