{"publication_id":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","content_hash":"sha256:81fbfbc704bd719b9e8ebf952d6ebeed6231208b79bb9fd2cb613dafa19853e4","nodes":[{"id":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","type":"publication","title":"Adjacent Evidence Brief: Therapeutic plasma exchange — full paper"},{"id":"claim_1","type":"claim","text":"This paper synthesizes evidence on Therapeutic plasma exchange across 28 accepted source papers and 1449 high-confidence extracted claims. The evidence profile contains 4 direct clinical sources, 24 adjacent clinical sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base. No single positive outcome class dominates the retained corpus; null signals cluster in the contextual adjacent evidence, immune and inflammation, safety and comorbidity outcome classes, and negative signals cluster in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect. The conclusion is that Therapeutic plasma exchange remains a bounded geroscience case: the retained clinical and adjacent evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim."},{"id":"claim_2","type":"claim","text":"This paper synthesizes evidence on Therapeutic plasma exchange across 28 accepted source papers and 1449 high-confidence extracted claims."},{"id":"claim_3","type":"claim","text":"The evidence profile contains 4 direct clinical sources, 24 adjacent clinical sources, and no sources classified primarily as mechanistic or model-system evidence, with a high-density pairwise disagreement map across the evidence base."},{"id":"claim_4","type":"claim","text":"No single positive outcome class dominates the retained corpus; null signals cluster in the contextual adjacent evidence, immune and inflammation, safety and comorbidity outcome classes, and negative signals cluster in the contextual adjacent evidence outcome class. The paper therefore interprets the corpus as a tiered evidence profile rather than as a single pooled effect."},{"id":"claim_5","type":"claim","text":"The conclusion is that Therapeutic plasma exchange remains a bounded geroscience case: the retained clinical and adjacent evidence profile defines the scope for targeted testing, while mixed and null findings limit any unqualified anti-aging claim."},{"id":"claim_6","type":"claim","text":"This manuscript is reported as a Thin-corpus evidence brief. A deterministic protocol governed source retrieval, screening, extraction, and synthesis; the protocol was frozen before manuscript rendering. The full audit trail is in the supplementary `methods_pack.json` and the timestamped submission directory `synthesis-therapeutic_plasma_exchange-v06-DAILY-2026-06-28T04-15-17Z`."},{"id":"claim_7","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text."},{"id":"claim_8","type":"claim","text":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification."},{"id":"claim_9","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (contextual adjacent evidence, dosing and pharmacokinetics, immune and inflammation, longevity, mortality and survival, safety and comorbidity); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_10","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_11","type":"claim","text":"Scope-framing note: This evidence map frames Therapeutic plasma exchange as clinical applications across heterogeneous indications rather than as standalone anti-aging or longevity proof. Aging-relevant interpretation is restricted to source rows whose endpoint, population, and outcome-class metadata directly support it; otherwise the retained evidence is contextual and hypothesis-generating."},{"id":"claim_12","type":"claim","text":"Boada 2020: A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=direct; tier=A1; finding=representative statistic P = .03; source-level statistic reported."},{"id":"claim_13","type":"claim","text":"Ipe 2021: Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence: outcome=Contextual Adjacent Evidence; direction=negative; directness=review; tier=B2; finding=representative statistic p ≥ 0.05; source-level statistic reported."},{"id":"claim_14","type":"claim","text":"Boada 2021: Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=review; tier=B2; finding=representative statistic P = .06; source-level statistic reported."},{"id":"claim_15","type":"claim","text":"Eichinger 2025: Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders: outcome=Immune and Inflammation; direction=null; directness=indirect; tier=B2; finding=representative statistic p < 0.05; source-level statistic reported."},{"id":"claim_16","type":"claim","text":"Lee 2026: Pediatric Therapeutic Plasma Exchange: Characterization of Practice, Epidemiology, and Safety Profile at a Children's Hospital in the United States: outcome=Safety and Comorbidity; direction=null; directness=indirect; tier=B2; finding=46 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_17","type":"claim","text":"Salur 2026: The Role of Therapeutic Plasma Exchange in the Management of Myeloma-Related Cast Nephropathy: A 10-Year Real-World Cohort Study: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p = 0.378; source-level statistic reported."},{"id":"claim_18","type":"claim","text":"Fuentealba 2025: Multi‐Omics Analysis Reveals Biomarkers That Contribute to Biological Age Rejuvenation in Response to Single‐Blinded Randomized Placebo‐Controlled Therapeutic Plasma Exchange: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p < 0.048; source-level statistic reported."},{"id":"claim_19","type":"claim","text":"Kohli 2022: Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=30 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_20","type":"claim","text":"Espana-Cueto 2025: Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial: outcome=Contextual Adjacent Evidence; direction=null; directness=direct; tier=A1; finding=26 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_21","type":"claim","text":"Thomas 2026: Severe autoimmune diffuse alveolar hemorrhage in children; early diagnosis and initiation of therapeutic plasma exchange may improve clinical outcomes: outcome=adjacent clinical-context evidence; direction=null; directness=indirect; tier=B2; finding=22 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_22","type":"claim","text":"Williams 2026: “In-Series” Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort, 2018–2022: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=21 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_23","type":"claim","text":"Kularathna 2026: Clinical Experience of Therapeutic Plasma Exchange (TPE) in Severe Leptospirosis: A Case Series from Sri Lanka: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=representative statistic p < 0.001; source-level statistic reported."},{"id":"claim_24","type":"claim","text":"Tupin 2026: Pathogen‐reduced plasma, cryoprecipitate reduced for therapeutic plasma exchange: outcome=Contextual Adjacent Evidence; direction=unclear; directness=indirect; tier=B2; finding=17 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_25","type":"claim","text":"Krzych 2021: What Is the Role of Therapeutic Plasma Exchange as an Adjunctive Treatment in Severe COVID-19: A Systematic Review: outcome=treatment or intervention-response evidence; direction=null; directness=review; tier=B2; finding=16 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_26","type":"claim","text":"Sgavardea 2026: Towards a clinical decision protocol for therapeutic plasma exchange based on biomarker patterns and machine learning: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=14 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_27","type":"claim","text":"Davidson 2022: Rescuing Cancer Immunity by Plasma Exchange in Metastatic Melanoma (ReCIPE-M1): protocol for a single-institution, open-label safety trial of plasma exchange to clear sPD-L1 for immunotherapy: outcome=Safety and Comorbidity; direction=null; directness=protocol; tier=D1; finding=12 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_28","type":"claim","text":"Raval 2026: Bleeding Risk Is Not Increased When Initiating Therapeutic Plasma Exchange in Adults Using Exclusively Albumin Replacement Fluid 2 Days After Percutaneous Kidney Biopsy: outcome=Safety and Comorbidity; direction=null; directness=indirect; tier=B2; finding=representative statistic p ≥ 0.05; source-level statistic reported."},{"id":"claim_29","type":"claim","text":"Ciobanu 2026: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Successful Therapeutic Plasma Exchange Treatment After SARS‐CoV‐2 Infection—A Case Report: outcome=Immune and Inflammation; direction=null; directness=indirect; tier=B2; finding=7 extracted claim(s); receipt-level direction is the coded finding."},{"id":"claim_30","type":"claim","text":"Nachtigall 2026: Neither Therapeutic Plasma Exchange nor High-Flux Hemodialysis Enhances the Removal of Chlorprothixene in Case of Intoxication despite a Drop in Plasma Levels: A Case Report: outcome=Contextual Adjacent Evidence; direction=null; directness=indirect; tier=B2; finding=6 extracted claim(s); receipt-level direction is the coded finding."},{"id":"source_1","type":"source","study":"Clinical and economic outcomes of therapeutic plasma exchange and intravenous immunoglobulin for treating adults with autoimmune neurological disorders: a systematic review and meta-analysis","year":2026,"doi":"10.1186/s12883-026-04780-1","url":"https://doi.org/10.1186/s12883-026-04780-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Kimber 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG) are high-cost treatments used for relapsed or refractory autoimmune neurological disorders. OBJECTIVE: To compare the effectiveness, safety and economic outcomes of therapeutic plasma exchange (TPE) compared with intravenous immunoglobulin (IVIG) for treating autoimmune neurological disorders. METHODS: MEDLINE, Embase, PubMed, The Cochrane Library, Transfusion Evidence Library, ClinicalTrials.gov and WHO ICTRP were searched from inception to 30th April 2025. Only randomised controlled trials (RCTs) involving people diagnosed with any autoimmune neurological disorders and comparing TPE with IVIG were included. Quality of the included studies was assessed via Cochrane risk of bias tool (ROB2). Meta-analysis was performed when feasible. Additionally, a rapid review was conducted on model-based economic evaluations for treating MG, GBS, and CIDP to identify and highlight existing gaps and limitations in included clinical trials for developing an economic model. A review protocol was pre-registered at PROSPERO 2024 CRD42024552257."},{"id":"source_2","type":"source","study":"A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study","year":2020,"doi":"10.1002/alz.12137","url":"https://doi.org/10.1002/alz.12137","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Boada 2020","excerpt":"INTRODUCTION: This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild-to-moderate Alzheimer's disease (AD). METHODS: Three hundred forty-seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6-week period of weekly conventional PE followed by a 12-month period of monthly low-volume PE), and placebo (sham). RESULTS: PE-treated patients performed significantly better than placebo for the co-primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog; P = .06; 66% less decline) scores at month 14. Moderate-AD patients (baseline Mini-Mental State Examination [MMSE] 18-21) scored better on ADCS-ADL (P = .002) and ADAS-Cog (P = .05), 61% less decline both. There were no changes in mild-AD patients (MMSE 22-26). PE-treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR-sb) (P = ."},{"id":"source_3","type":"source","study":"Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence","year":2021,"doi":"10.3389/fneur.2021.662856","url":"https://doi.org/10.3389/fneur.2021.662856","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ipe 2021","excerpt":"Background: Patients with Myasthenia Gravis (MG) can be treated acutely with therapeutic plasma exchange (TPE) or intravenous immune globulin (IVIG). To date, there is no definitive understanding of which of the two treatments is more effective and safer. The purpose of this study was to systematically review the literature on the comparative efficacy and safety of TPE to other available treatments for MG. Methods: A systematic literature search for studies published between 1997 and 2017 was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using two database sources, MEDLINE (through the PubMed database) and Cochrane Library. Results: The search strategy resulted in 535 articles whose abstracts were reviewed. Among these, 165 full texts articles were reviewed for eligibility and 101 articles were excluded. Of the 165 articles, 64 articles were included for a systematic literature and 11 articles for a meta-analysis. Conclusions: This systematic literature review and meta-analysis of treatment options showed that there was a higher response rate with TPE than IVIG in acute MG patients and patients undergoing thymectomy."},{"id":"source_4","type":"source","study":"Neuropsychological, neuropsychiatric, and quality‐of‐life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study","year":2021,"doi":"10.1002/alz.12477","url":"https://doi.org/10.1002/alz.12477","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Boada 2021","excerpt":"INTRODUCTION: We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS: Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS: The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION: PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD."},{"id":"source_5","type":"source","study":"Complications of Therapeutic Plasma Exchange in Pediatric Neuroimmune Disorders","year":2025,"doi":"10.3390/children12111457","url":"https://doi.org/10.3390/children12111457","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Eichinger 2025","excerpt":"Background: Therapeutic plasma exchange (TPE) is an established treatment for immune-mediated neurological diseases in adults, but pediatric-specific data remain limited. This retrospective single-center study investigates the safety, complication profile, and clinical outcomes of TPE in children with pediatric neuroimmunological disorders (PNID). Methods: Medical records of pediatric patients who underwent TPE at the Medical University of Vienna between April 2006 and October 2022 were reviewed. Inclusion criteria required TPE initiation before the age of 18 years. Data collected included diagnoses, pre-TPE therapy, TPE characteristics, complications and clinical outcomes based on retrospective documentation. Results: A total of 53 patients (60% female, median age 13 years) were included and underwent 378 TPE procedures. Most common diagnoses were pediatric-onset multiple sclerosis (23%) and autoimmune encephalitis (19%). TPE was preceded by corticosteroids and/or intravenous immunoglobulin in 83% of patients."},{"id":"source_6","type":"source","study":"Pediatric Therapeutic Plasma Exchange: Characterization of Practice, Epidemiology, and Safety Profile at a Children's Hospital in the United States","year":2026,"doi":"10.1002/jca.70128","url":"https://doi.org/10.1002/jca.70128","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Lee 2026","excerpt":"There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice."},{"id":"source_7","type":"source","study":"The Role of Therapeutic Plasma Exchange in the Management of Myeloma-Related Cast Nephropathy: A 10-Year Real-World Cohort Study","year":2026,"doi":"10.3390/jcm15020417","url":"https://doi.org/10.3390/jcm15020417","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Salur 2026","excerpt":"Background: Renal impairment is a frequent and severe complication of multiple myeloma, most commonly caused by light-chain cast nephropathy. Therapeutic plasma exchange (TPE) has been proposed as an adjunctive approach to rapidly reduce circulating free light chains; however, its clinical benefit remains controversial. Methods: We retrospectively analyzed 71 patients treated between 2013 and 2023, of whom 30 received TPE in addition to anti-myeloma therapy and 41 received anti-myeloma therapy alone. Renal outcomes were assessed within a predefined early treatment window encompassing the first 4-6 cycles of therapy. Renal response was defined as a ≥50% reduction in serum creatinine and/or dialysis independence. Multivariable logistic regression and sensitivity analyses were performed to adjust for baseline imbalances, including renal function and anti-myeloma backbone therapy. Results: Although renal function improved significantly over time in both groups, renal response rates were comparable between patients treated with and without TPE (40% vs. 36.6%). In multivariable analysis, TPE was not independently associated with renal response."},{"id":"source_8","type":"source","study":"Multi‐Omics Analysis Reveals Biomarkers That Contribute to Biological Age Rejuvenation in Response to Single‐Blinded Randomized Placebo‐Controlled Therapeutic Plasma Exchange","year":2025,"doi":"10.1111/acel.70103","url":"https://doi.org/10.1111/acel.70103","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Fuentealba 2025","excerpt":"We conducted a randomized, placebo-controlled trial to assess the safety and biological age (BA) effects of various therapeutic plasma exchange (TPE) regimens in healthy adults over 50. Participants received bi-weekly TPE with or without intravenous immunoglobulin (IVIG), monthly TPE, or placebo. Randomization was based on entry date, and treatments were blinded to maintain objectivity. Primary objectives were to assess long-term TPE safety and changes in biological clocks. Secondary goals included identifying optimal regimens. Exploratory analyses profiled baseline clinical features and longitudinal changes across the epigenome, proteome, metabolome, glycome, immune cytokines, iAge, and immune cell composition. We demonstrate in 42 individuals randomized to various treatment arms or placebo that long-term TPE was found to be safe, with only two adverse events requiring discontinuation and one related to IVIG. TPE significantly improved biological age markers, with 15 epigenetic clocks showing rejuvenation compared to placebo (FDR < 0.05)."},{"id":"source_9","type":"source","study":"Assessment of clinical characteristics, treatment responses, relapses, and survival in patients with thrombotic thrombocytopenic purpura undergoing therapeutic plasma exchange: A single-center experience","year":2026,"doi":"10.12669/pjms.42.4.14962","url":"https://doi.org/10.12669/pjms.42.4.14962","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Dogan 2026","excerpt":"OBJECTIVE: The present study evaluates the clinical characteristics, laboratory values, treatment responses, relapse rates, and survival outcomes in patients diagnosed with thrombotic thrombocytopenic purpura (TTP) undergoing therapeutic plasma exchange (TPE). METHODOLOGY: Included in this retrospective single-center study were 55 patients who underwent TPE with a diagnosis of TTP between 2012 to 2025. The study was conducted between October and December 2025 at Van Yuzuncu Yil University Medical Faculty Hospital. Demographic characteristics, clinical findings, laboratory results, administered therapies, complications, treatment responses, and survival data were retrieved from the hospital automation system and patient medical records. RESULTS: The median age of the patients was 34 years, and 67.3% were female. Based on PLASMIC scores, 76.4% of the patients were classified as high risk, among whom 36.4% tested positive for an ADAMTS13 inhibitor (a disintegrin and metalloproteinase with a thrombospondin type-1 motif, member 13). The complete response rate to TPE was 75.5%, whereas the relapse rate was 23.6%, and among those who relapsed, 84."},{"id":"source_10","type":"source","study":"Modulation of Cytokines and Immune Cells by Plasma Exchange in Patients With Certain Autoimmune Neurological Diseases","year":2026,"doi":"10.1002/iid3.70369","url":"https://doi.org/10.1002/iid3.70369","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Xu 2026","excerpt":"Clinical outcomes were evaluated 1 month after the TPE course using the modified Rankin Scale. The inclusion criteria were as follows: (1) Age > 14 years; (2) In accordance with the 2019 ASFA guidelines [ 8 ], and the best practice recommendations [ 9 ], we selected patients with autoimmune neurological diseases for TPE by recognizing their distinct clinical symptoms, notable laboratory findings, atypical imaging results, and by ruling out other possible diagnose; (3) Patients provided voluntary informed consent."},{"id":"source_11","type":"source","study":"Effect on haemostasis of different replacement fluids during therapeutic plasma exchange—A comparative multicentre observational study","year":2022,"doi":"10.1002/jca.22008","url":"https://doi.org/10.1002/jca.22008","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Kohli 2022","excerpt":"INTRODUCTION: Therapeutic plasma exchange (TPE) is used for several chronic conditions with little evidence on the efficacy and safety of different choice of replacement fluid. Measurement of haemostasis, particularly in vitro thrombin generation, could play a role in determining the immediate efficacy of different fluid replacement. AIM: To determine the impact of different TPE replacement fluid regimens on haemostatic assays. METHODS: Prospective observational multi-centre cohort study in adult patients 18 years and older evaluating haemostatic changes between four different TPE regimens: (1) 5% human albumin solution (Alb) only, (2) 50:50 mix of 5% Alb + modified gelatin, (3) 70:30 mix of 5% Alb and normal saline (NS), and (4) solvent-detergent, virus-inactivated fresh frozen plasma (FFP) (either alone or combined with other fluids). Twenty-one haemostasis variables were analysed (procoagulant, anticoagulant and fibrinolytic factors) pre and post TPE sessions, including in vitro thrombin generation. Linear mixed modelling and canonical discriminant analyses were used to examine the effect of TPE fluid type on haemostatic variables."},{"id":"source_12","type":"source","study":"Therapeutic plasma exchange in patients with sepsis: Secondary analysis of a cluster‐randomized controlled trial","year":2023,"doi":"10.1002/jca.22027","url":"https://doi.org/10.1002/jca.22027","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Luo 2023","excerpt":"INTRODUCTION: Sepsis is life-threatening organ dysfunction caused by infection-related inflammatory response. Therapeutic plasma exchange (TPE) can remove inflammatory mediators and benefit patients in different disease settings. However, no solid evidence showed the efficacy and safety of TPE in sepsis. METHODS: This study was a secondary analysis of a randomized controlled trial. Critically ill patients with sepsis were divided into two groups according to whether treated with TPE. The primary outcome was the delta Sequential Organ Failure Assessment (SOFA) score from days 1 to 7. Secondary outcomes included new-onset organ failure, intensive care unit (ICU)-free and alive days to day 28, and 28-day mortality. Propensity score-matched (PSM) analysis was applied to control confounders. Analysis of covariance (ANCOVA) and logistic regression were used to assess the association between TPE and selected outcomes. RESULTS: Among the 2772 critically ill patients enrolled in the trial, 742 patients with sepsis were selected and 22 patients received TPE were matched with 22 control patients."},{"id":"source_13","type":"source","study":"Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial","year":2025,"doi":"10.1038/s41467-025-57198-7","url":"https://doi.org/10.1038/s41467-025-57198-7","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Espana-Cueto 2025","excerpt":"The post-COVID-19 condition (PCC) is a highly debilitating and persistent postinfectious syndrome that affects millions of people worldwide and has no effective treatment. Therapeutic plasma exchange (TPE) has the potential to improve the PCC by clearing the peripheral soluble pro-inflammatory immune milieu derived from acute or persistent SARS-CoV-2 infection. In a phase II, double-blind, placebo-controlled, randomized trial, fifty subjects with PCC were randomly assigned (1:1) to receive six sessions of either TPE or a sham plasma exchange and were followed for 90 days (ClinicalTrials.gov registration: NCT05445674). The primary endpoint was safety; secondary endpoints included functional status, symptomology, quality of life, neurocognitive symptoms, and peripheral biochemistry, hematology, coagulation and inflammation parameters. Both study arms had a similarly favorable safety profile. There were no diferences between groups in any of the efficacy parameters evaluated. Whereas TPE is safe, it did not lead to any discernible improvement of the PCC in this clinical trial."},{"id":"source_14","type":"source","study":"Severe autoimmune diffuse alveolar hemorrhage in children; early diagnosis and initiation of therapeutic plasma exchange may improve clinical outcomes","year":2026,"doi":"10.3389/fped.2026.1799535","url":"https://doi.org/10.3389/fped.2026.1799535","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Thomas 2026","excerpt":"INTRODUCTION: Diffuse alveolar hemorrhage (DAH) is a rare but life-threatening pulmonary complication in children, presenting with hemoptysis, anemia, diffuse infiltrates, and respiratory failure. Autoimmune diseases such as systemic lupus erythematosus (SLE) and ANCA-associated vasculitis (AAV) account for 30%-40% of pediatric DAH cases. Pediatric evidence is limited to case reports and small series. We aimed to characterize the clinical course, management, and outcomes of pediatric patients with autoimmune DAH requiring intensive care. METHODS: We conducted a retrospective cohort study at a single tertiary pediatric institution, identifying 6 patients admitted to the ICU from 2013 to 2024 with DAH secondary to SLE or AAV. RESULTS: All six patients (5 females; age 14-17) were critically ill. Five required MV (median 18 days, IQR: 18-25), two required high-frequency oscillatory ventilation (HFOV) (6, 10 days), and three required VV-ECMO (8, 9, and 45 days). Four had new-onset autoimmune diagnoses on admission. All received high-dose corticosteroids and therapeutic plasma exchange (TPE) (mean 6.5 ± 2."},{"id":"source_15","type":"source","study":"“In-Series” Continuous Renal Replacement Therapy and Therapeutic Plasma Exchange: Single-Center Retrospective Cohort, 2018–2022","year":2026,"doi":"10.1097/PCC.0000000000003942","url":"https://doi.org/10.1097/PCC.0000000000003942","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Williams 2026","excerpt":"OBJECTIVES: To describe our use and experience with an \"in-series\" approach for patients requiring both continuous renal replacement therapy (CRRT) as well as therapeutic plasma exchange (TPE). DESIGN: Retrospective review of case notes. SETTING: General and cardiac PICUs at the Royal Children's Hospital in Melbourne, VIC, Australia. PATIENTS: Children (0-18 yr old) requiring both CRRT and TPE between 2018 and 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twelve children were successfully and safely treated with 32 TPE sessions and 38 CRRT sessions with our in-series CRRT and TPE setup using a total of 20 extracorporeal circuits and 11 additional plasma filters or hemofilters. This represents a reduction of 71% in standard circuit usage. CONCLUSIONS: Our approach to providing \"in-series\" CRRT and TPE used existing access and circuits, a single device, and resulted in efficient treatments, reduced infection risk, reduced exposure to circuits, less hemodilution, and less blood product use. Small potential cost and waste reductions were also achieved. This approach was performed safely with no unexpected adverse events."},{"id":"source_16","type":"source","study":"Clinical Experience of Therapeutic Plasma Exchange (TPE) in Severe Leptospirosis: A Case Series from Sri Lanka","year":2026,"doi":"10.3390/tropicalmed11050132","url":"https://doi.org/10.3390/tropicalmed11050132","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Kularathna 2026","excerpt":"BACKGROUND: Leptospirosis is a globally prevalent zoonosis with significant morbidity and mortality, especially in tropical regions like South Asia. In its severe form, the disease often leads to multiorgan dysfunction, with pulmonary haemorrhage being a major cause of death. Evidence supporting specific treatments for severe leptospirosis with pulmonary involvement remains limited. Recent studies suggest that immunomodulatory therapies, such as therapeutic plasma exchange (TPE), may offer survival benefits. This case series explores the application and outcomes of TPE in patients with severe leptospirosis at a tertiary care hospital in Sri Lanka. METHODS: We studied a case series involving nine patients with confirmed severe leptospirosis and multiorgan involvement from September 2021 to October 2022. All patients received standard care, including intravenous antibiotics and methylprednisolone. TPE was initiated in all nine patients based on clinical severity, particularly in the presence of pulmonary haemorrhage. Clinical, laboratory, and radiological data were collected from patient records and follow-up. Leptospirosis diagnosis was confirmed through ELISA IgM testing."},{"id":"source_17","type":"source","study":"Pathogen‐reduced plasma, cryoprecipitate reduced for therapeutic plasma exchange","year":2026,"doi":"10.1111/trf.70099","url":"https://doi.org/10.1111/trf.70099","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Tupin 2026","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) for thrombotic thrombocytopenic purpura (TTP) and auto-immune disorders involves repeated patient exposure to allogenic plasma with the risk of transfusion-transmitted infection (TTI). Amotosalen-UVA Pathogen Reduction technology is FDA approved to manufacture pathogen-reduced plasma, cryoprecipitate reduced (PRPCR), a form of cryoprecipitate poor plasma (CPP) with potentially improved TPE outcomes and reduced TTI risk. METHODS: PRPCR was manufactured from pathogen-reduced (PR) plasma. Thrombin generation, fibrinogen, Factors II, V, VII, VIII, IX, X, XI, XIII, VWF, ADAMTS13, Protein C, Protein S, α-2 plasmin inhibitor (α-2 PI), IgG, IgM, and IgA were measured. Microfluidic chamber assays at variable shear rates characterized PRPCR-mediated platelet adhesion and aggregation. RESULTS: Compared to PR plasma, fibrinogen, Factor VIII, and VWF levels were depleted in PRPCR. Factors II, V, VII, IX, X, XI, XIII, thrombin generation, Protein C, Protein S, α-2 PI, ADAMTS13, and immunoglobulins were conserved. At low wall shear rates (300 s -1 ) PRPCR supported platelet adhesion."},{"id":"source_18","type":"source","study":"What Is the Role of Therapeutic Plasma Exchange as an Adjunctive Treatment in Severe COVID-19: A Systematic Review","year":2021,"doi":"10.3390/v13081484","url":"https://doi.org/10.3390/v13081484","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Krzych 2021","excerpt":"INTRODUCTION: Since the COVID-19 pandemic outbreak, multiple promising treatment modalities have been tested, however, only several of them were proven to be effective. Therapeutic plasma exchange (TPE) has been recently discussed as a possible supportive treatment for severe cases. METHODS: To investigate a possible role of TPE in severe COVID-19 we used a structured systematic search strategy to retrieve all relevant publications in the field. We screened in PubMed, EMBASE, Web of Science, Cochrane Library and clinicaltrials.gov for data published until the 4 June 2021. RESULTS: We identified 18 papers, enrolling 384 patients, 220 of whom received TPE. The number of TPE sessions ranged from 1 to 9 and the type of replacement fluid varied markedly between studies (fresh frozen plasma or 5% albumin solution, or convalescent plasma). Biochemical improvement was observed in majority of studies as far as C-reactive protein (CRP), interleukin-6 (IL-6), ferritin, lactate dehydrogenase (LDH), D-dimer concentrations and lymphocyte count are concerned. The improvement at a laboratory level was associated with enhancement of respiratory function."},{"id":"source_19","type":"source","study":"Towards a clinical decision protocol for therapeutic plasma exchange based on biomarker patterns and machine learning","year":2026,"doi":"10.1186/s12911-026-03484-3","url":"https://doi.org/10.1186/s12911-026-03484-3","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Sgavardea 2026","excerpt":"INTRODUCTION: Therapeutic plasma exchange (TPE) is increasingly used as an adjunctive intervention in severe, hyperinflammatory critical illness, including COVID-19, yet clinical guidance remains syndromic and evidence is heterogeneous. We present an integrated, interpretable machine-learning framework designed to support protocolizable TPE decision-making by identifying biochemical phenotypes associated with short-horizon laboratory response to TPE. Our dataset consists of real-world intensive care unit cases and captures the treatment heterogeneity and operational constraints that a workable institutional protocol must accommodate, being well-suited as a “protocol seed” for iterative validation. METHODS: We jointly analyze a COVID-19 cohort and a non-COVID comparator cohort receiving TPE. Three decision trees were constructed to represent: (1) global biochemical improvement, (2) strict improvement dependent on key inflammatory/coagulation markers, and (3) early interleukin-6 (IL-6) response. The models revealed distinct favorable phenotypes—particularly patients with IL-6 > 86 pg/mL, lactate dehydrogenase (LDH) >346 U/L, lymphopenia, and fibrinogen ≤ 8.3 g/L."},{"id":"source_20","type":"source","study":"Rescuing Cancer Immunity by Plasma Exchange in Metastatic Melanoma (ReCIPE-M1): protocol for a single-institution, open-label safety trial of plasma exchange to clear sPD-L1 for immunotherapy","year":2022,"doi":"10.1136/bmjopen-2021-050112","url":"https://doi.org/10.1136/bmjopen-2021-050112","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"protocol","cited_as":"Davidson 2022","excerpt":"BACKGROUND: Patients with metastatic melanoma rely on PD-(L)1 immunotherapy, but only one-third of patients experience treatment response and all initial responders eventually develop resistance. Tumour-derived extracellular vesicles expressing Programmed death ligand 1 (evPD-L1) and soluble Programmed death ligand 1 (sPD-L1) in peripheral blood of patients with melanoma limit PD-(L)1 immunotherapy and correlate with poor survival. Therapeutic plasma exchange (TPE) removes immunosuppressive evPD-L1 and sPD-L1. We hypothesise that TPE may rescue and restore antimelanoma immunity. METHODS: In this two-arm study, 60 patients with metastatic melanoma progressing on checkpoint inhibition will be accrued. All patients will undergo radiotherapy on days 1-5 (at least one measurable lesion will not be irradiated) and ongoing checkpoint inhibition on day 8 and every 2-3 weeks per standard of care. Patients with baseline sPD-L1 level of ≥1.7 ng/mL and adequate clinical capacity will be enrolled in the TPE intervention arm and will undergo TPE on days 5-7, in addition to standard of care radiotherapy and immunotherapy. Other patients will remain in the standard of care arm."},{"id":"source_21","type":"source","study":"Bleeding Risk Is Not Increased When Initiating Therapeutic Plasma Exchange in Adults Using Exclusively Albumin Replacement Fluid 2 Days After Percutaneous Kidney Biopsy","year":2026,"doi":"10.1002/jca.70122","url":"https://doi.org/10.1002/jca.70122","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Raval 2026","excerpt":"The practice of selecting replacement fluid for therapeutic plasma exchange (TPE) after percutaneous kidney biopsy is variable and often depends on the number of days after biopsy that the apheresis treatment plan is initiated. It has been previously reported that most centers utilize plasma for at least part of replacement fluid for TPE after kidney biopsy, and quite often for many days. In this retrospective study, 100 consecutive patients who underwent percutaneous kidney biopsy and had TPE initiated 2 days after biopsy were analyzed. Half of these patients had exclusively albumin replacement fluid, and the other half had replacement fluid with both albumin and plasma. Rates for bleeding at the kidney biopsy site were identical and occurred in 1 patient (2%) in each cohort. Future studies assessing bleeding risk in this patient population receiving TPE should concentrate on the duration within 1 day after percutaneous kidney biopsy."},{"id":"source_22","type":"source","study":"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Successful Therapeutic Plasma Exchange Treatment After SARS‐CoV‐2 Infection—A Case Report","year":2026,"doi":"10.1002/ccr3.72725","url":"https://doi.org/10.1002/ccr3.72725","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Ciobanu 2026","excerpt":"Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex neuroimmunological disorder characterized by disabling symptoms that are often difficult to manage. More recently, in the context of SARS-CoV-2 infection, potential pathophysiological overlaps and disease modulation have been hypothesized. Our successful case highlights the need to investigate novel therapeutic approaches, including plasma exchange."},{"id":"source_23","type":"source","study":"Neither Therapeutic Plasma Exchange nor High-Flux Hemodialysis Enhances the Removal of Chlorprothixene in Case of Intoxication despite a Drop in Plasma Levels: A Case Report","year":2026,"doi":"10.1159/000551514","url":"https://doi.org/10.1159/000551514","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Nachtigall 2026","excerpt":"INTRODUCTION: Chlorprothixene is a typical antipsychotic, primarily used in the treatment of psychotic disorders. Overdose may result in severe cardiovascular and central nervous system toxicity. Evidence on the effectiveness of extracorporeal elimination is scarce. CASE PRESENTATION: A 19-year-old female ingested 5 g of chlorprothixene in a suicide attempt. Upon admission to the intensive care unit, she was awake, responsive, and oriented. Initial management included 50 g of activated charcoal. As doses of >2 g chlorprothixene can cause severe intoxication and death, attempts to enhance drug elimination by extracorporeal therapy were undertaken. Therapeutic plasma exchange (TPE) was initiated approximately 3 h after admission, exchanging 5,096 mL of plasma with albumin solution and FFP over 3 h 10 min. This was followed by a 10 h 10 min prolonged intermittent kidney replacement therapy (PIKRT). Serial blood, apheresis, and dialyzate samples were collected to quantify drug removal. Both procedures were well tolerated. The patient remained clinically stable and was transferred to a psychiatric facility 24 h post-admission."},{"id":"source_24","type":"source","study":"Clinical response of acute idiopathic polyradiculoneuritis treated with therapeutic plasma exchange in four dogs","year":2026,"doi":"10.1093/jvimsj/aalag090","url":"https://doi.org/10.1093/jvimsj/aalag090","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Dazio 2026","excerpt":"Acute idiopathic polyradiculoneuritis (AIP) is an immune-mediated peripheral neuropathy in dogs for which no specific treatment has been established in veterinary medicine. In human medicine, therapeutic plasma exchange (TPE) is a standard treatment for Guillain-Barré syndrome, a clinically analogous condition. In this case series, we describe 4 dogs diagnosed with AIP and treated with TPE. All dogs received 3 consecutive TPE sessions, processing between 4.2 and 4.8 total dog plasma volumes. Motor function improvement was observed after the first session in all cases, with near-complete neurological recovery at discharge. No adverse effects were reported. During follow-up (2-12 months), 3 dogs remained disease-free, and 1 dog experienced a recurrence that subsequently resolved. These cases suggest that TPE might promote rapid clinical improvement in dogs with AIP, representing a promising emergency treatment option for dogs with severe and rapidly progressive neurological deficits."},{"id":"source_25","type":"source","study":"Case Report: Successful management of acute vincristine overdose in a cat with metastatic gastric lymphoma using therapeutic plasma exchange","year":2026,"doi":"10.3389/fvets.2026.1791728","url":"https://doi.org/10.3389/fvets.2026.1791728","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Yeh 2026","excerpt":"A 10-year-old male castrated Siamese cat with gastric large B-cell lymphoma was presented following an accidental overdose of vincristine, four times the intended dose. The initial management involved administering intravenous lipid emulsion. Extracorporeal therapy was implemented to reduce plasma vincristine concentrations, beginning with therapeutic plasma exchange (TPE) and followed by hemoperfusion (HP). Vincristine clearance was not confirmed through pre- and post-treatment serum levels due to a laboratory handling error. The patient became apneic at the initiation of HP, prompting discontinuation of treatment and completion of TPE alone. Post-TPE management combined intensive supportive care with the administration of cholestyramine, calcium folinate, and granulocyte colony-stimulating factor. The cat survived to discharge, suggesting a potential role for extracorporeal therapy in managing chemotherapeutic toxicity. However, the absence of pre- and post-treatment serum vincristine levels prevents a definitive assessment of therapeutic efficacy."},{"id":"source_26","type":"source","study":"Separate (Asynchronous) Therapeutic Plasma Exchange (TPE) and Plasma Transfusion in the Patient with Severe TPE Complications: A Case Report","year":2025,"doi":"10.18502/ijhoscr.v19i1.17827","url":"https://doi.org/10.18502/ijhoscr.v19i1.17827","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Anvari 2025","excerpt":"Thrombotic thrombocytopenic purpura (TTP) is a medical condition characterized by a decreased activity of the ADAMTS13 protease for cleaving the von Willebrand factor. It contributes to thrombotic microangiopathy. In this report, we described a case of TTP followed by significant adverse effects during therapeutic plasma exchange (TPE) treatment. The patient received TPE with a time interval from plasma transfusion. A 30-year-old female was evaluated for headaches and bruises on her arms and legs. Laboratory testing revealed thrombocytopenia and anemia. The identification of thrombocytopenia with severe schistocytosis was verified by the analysis of a peripheral blood smear. After confirming a diagnosis of TTP, TPE was performed as therapy. To avoid the complications arising during the previous TPE sessions, we conducted plasma exchange with albumin followed by FFP injection, with a six-hour interval between them. This strategy successfully alleviated the patient's symptoms. Therapeutic plasma exchange (TPE) with a time interval from plasma transfusion can be successfully used in patients with severe TPE complications."},{"id":"source_27","type":"source","study":"Therapeutic plasma exchange for fibrinogen-associated hyperviscosity: results of the COVID-19 PLasma EXchange (COPLEX) randomized controlled trial.","year":2025,"doi":"10.1016/j.jtha.2024.12.021","url":"https://doi.org/10.1016/j.jtha.2024.12.021","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"direct","cited_as":"Maier 2025","excerpt":"BACKGROUND: Therapeutic plasma exchange (TPE) is the primary intervention for treating symptomatic hyperviscosity from hypergammaglobulinemia, yet its efficacy for treating hyperviscosity related to hyperfibrinogenemia is unclear. OBJECTIVES: Define the safety and efficacy of TPE for critically ill COVID-19 patients with elevated blood viscosity from hyperfibrinogenemia. METHODS: We performed a prospective randomized controlled trial in critically ill COVID-19 patients in a single US healthcare system. Patients with hyperfibrinogenemia (>800 mg/dL) or elevated plasma viscosity (2.3-3.5 centipoise [cP]) were randomized to receive TPE on 2 consecutive days or continued standard of care (SOC). RESULTS: Twenty participants were enrolled, with 10 receiving TPE and 10 receiving SOC alone. Mean (±SEM) plasma viscosity decreased significantly from 2.35 cP (±0.12) to 1.61 cP (±0.03) in the TPE group and was unchanged in the SOC group (2.47 cP [±0.11] to 2.47 cP [±0.15]). Mean fibrinogen decreased from 934.0 mg/dL (±25.1) to 359.1 mg/dL (±22.5) after TPE vs from 859.6 mg/dL (±57.6) to 807.3 mg/dL (±63.1) in SOC."},{"id":"source_28","type":"source","study":"Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report","year":2020,"doi":"10.1186/s12872-020-01665-0","url":"https://doi.org/10.1186/s12872-020-01665-0","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Faqihi 2020","excerpt":"BACKGROUND: Fulminant (life-threatening) COVID-19 can be associated with acute respiratory failure (ARF), multi-system organ failure and cytokine release syndrome (CRS). We present a rare case of fulminant COVID-19 associated with reverse-takotsubo-cardiomyopathy (RTCC) that improved with therapeutic plasma exchange (TPE). CASE PRESENTATION: A 40 year old previous healthy male presented in the emergency room with 4 days of dry cough, chest pain, myalgias and fatigue. He progressed to ARF requiring high-flow-nasal-cannula (flow: 60 L/minute, fraction of inspired oxygen: 40%). Real-Time-Polymerase-Chain-Reaction (RT-PCR) assay confirmed COVID-19 and chest X-ray showed interstitial infiltrates. Biochemistry suggested CRS: increased C-reactive protein, lactate dehydrogenase, ferritin and interleukin-6. Renal function was normal but lactate levels were elevated. Electrocardiogram demonstrated non-specific changes and troponin-I levels were slightly elevated. Echocardiography revealed left ventricular (LV) basal and midventricular akinesia with apex sparing (LV ejection fraction: 30%) and depressed cardiac output (2."}],"edges":[{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_1","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_2","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_3","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_4","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_5","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_6","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_7","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_8","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_9","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_10","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_11","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_12","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_13","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_14","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_15","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_16","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_17","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_18","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_19","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_20","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_21","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_22","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_23","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_24","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_25","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_26","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_27","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_28","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_29","type":"contains_claim"},{"from":"21652f17-8a22-4863-aa37-ec5f4e1a7b90","to":"claim_30","type":"contains_claim"}],"screening":{"identified":28,"screened":28,"excluded":0,"included":28,"included_or_retained":28,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"28 candidate receipts retained after source retrieval, deduplication, and topic filtering. 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