Complications of Therapeutic Plasma Exchange in Intoxication

The clinical application of therapeutic plasma exchange (TPE) is rapidly increasing in patients with intoxication caused by known or suspected exposure to drugs or toxic substances. The therapeutic impact in such cases includes the removal of drugs/toxic substances, correction of biochemical and metabolic abnormalities, and rapid clinical improvement. Patients with intoxication caused by drugs or toxic substances with high protein-binding affinity are good candidates for TPE. The American Society for Apheresis published guidelines in 2019 on the definitive indications for TPE but provided insufficient data on its use in cases of intoxication. TPE in patients with overdose and intoxication is a Category II and III recommendation in cases of Amanita phalloides mushroom intoxication and other intoxications, respectively. Although TPE is considered an effective procedure in selected poisoned patients, some complications can occur. These complications may involve blood access, replacement fluids, the procedure itself, or the use and type of anticoagulants. Serious complications may also occur occasionally. Therefore, awareness of these complications and taking the necessary precautions is crucial.