William F. Clark, MD; Gail A. Rock, PhD, MD; Noel Buskard, MD; Kenneth H. Shumak, MD; Pierre LeBlond, MD; David Anderson, MD; David M. Sutton, MD; for the Canadian Apheresis Group*
For members of the Canadian Apheresis Group, see Appendix.
Requests for Reprints: William F. Clark, MD, Division of Nephrology, London Health Sciences Centre, Victoria Campus, 375 South Street, London, Ontario N6A 4G5, Canada.
Current Author Addresses: Dr. Clark: Division of Nephrology, London Health Sciences Centre, Victoria Campus, 375 South Street, London, Ontario N6A 4G5, Canada.
Dr. Rock: Ottawa Hospital and Canadian Apheresis Group, 270 Sandridge Road, Ottawa, Ontario K1L 5A2, Canada.
Dr. Buskard: Vancouver Hospital and Health Centre, 910 10th Avenue West, Vancouver, British Columbia V5Z 4E3, Canada.
Dr. Shumak: Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada.
Dr. LeBlond: Hôpital du St. Sacrement, 1050 Chemin Ste-Foy, Quebec, Quebec G1S 4L8, Canada.
Dr. Anderson: Victoria General Hospital, MB132-1278 Tower Road, Halifax, Nova Scotia B3H 2Y9, Canada.
Dr. Sutton: The Toronto Hospital, 037-200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
In 1997, the Canadian Apheresis Group reviewed data on 103 416 plasma exchange procedures that had been collected since 1980. Although the number of plasma exchanges gradually increased (from 3189 to 8208 per year), the pattern changed. In 1981, the five most frequent indications for plasma exchange resulted in 55% of all such procedures; by 1997, the five most frequent indications for plasma exchange resulted in 81.1% of all such procedures. During this period, three conditions that were originally among the most frequent indications for plasma exchange became among the least frequent. This paper reviews the published evidence that supports or refutes the use of plasma exchange in the category of the five most frequent indications from 1981 to 1997: thrombotic thrombocytopenic purpura, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, Waldenstrom macroglobulinemia, the Guillain-Barré syndrome, rheumatoid arthritis, systemic lupus erythematosus, and multiple sclerosis. For most disorders, use of plasma exchange procedures is correlated with published evidence, and the changing patterns of plasma exchange use by members of the Canadian Apheresis Group reflect published evidence. Annual center-by-center reviews of use of plasma exchange may also have influenced practice patterns.
William F. Clark, Gail A. Rock, Noel Buskard, Kenneth H. Shumak, Pierre LeBlond, David Anderson, et al. Therapeutic Plasma Exchange: An Update from the Canadian Apheresis Group. Ann Intern Med. 1999;131:453–462. doi: 10.7326/0003-4819-131-6-199909210-00011
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Published: Ann Intern Med. 1999;131(6):453-462.
Hematology/Oncology, Lupus Erythematosus, Neurology, Rheumatology, Updates.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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