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12.18 Neurology led, outpatient plasma exchange: the wessex experience
  1. Rachel Jennings,
  2. Chinar Osman,
  3. Katie Hill,
  4. Joanna Kitley,
  5. Ashwin Pinto
  1. Southampton General Hospital

Abstract

Introduction Plasma Exchange (PLEX) is a proven treatment for many antibody-mediated neurological diseases, appearing equally efficacious as intravenous immunoglobulins (IVIG) in the majority of conditions. In Wessex, PLEX was previously only available using a membrane-filtration device, requiring central venous access and a high care environment. Increasing restrictions on IVIG alongside bed capacity constraints prompted us to develop a neurology-led, outpatient, centrifuge PLEX service. To our knowledge, this is the first service of its kind in the U.K. We describe our experience over the first eighteen months and compare pre- and post-service development audit data.

Results Prior to the outpatient service, mean length of stay for elective patients was 10.7 days. The new service has facilitated outpatient PLEX for all elective patients. For inpatient (emergency) PLEX, mean delay from referral to first exchange reduced from 3.7 days to 1.8 days.

Overall, 59% of all plasma exchanges were performed via peripheral access with no major complications in this group.

Conclusion The new service has facilitated delivery of outpatient PLEX, reduced demand for neurology inpatient beds and reduced treatment delay. Use of peripheral access has also reduced complication rates. Given the national shortage of IVIG, investment in PLEX is essential for neurology services.

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