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1. The Turkish experience with therapeutic plasma exchange: A national survey

Author

Korkmaz, S., Solmaz Medeni, S., Demirkan, Fatih, Kalayoglu Besisik, S., Altay Dadin, S., Akgün Cağlıyan, Gülsüm, Kabukcu Hacioglu, S., Sari, I., Goren Sahin, D., Arat, M., Dagdas, S., Ozet, G., Kutlu, N., Karaagac Akyol, T., Ozcebe, O.I., Uskudar Teke, H., Kiper Unal, D., Guner, N., Tombak, A., Celik, H., Bay, I., Kiki, I., Ozgur, G., Erkurt, M.A., Ozatli, D., Meletli, O., Demircioglu, S., Demir, C., Kurtoglu, E., Vural, F., Tobu, M., Karakus, A., Ayyildiz, O., Dal, M.S., Afacan Ozturk, B., Albayrak, M., Ocakci, S., Bolaman, Z., Sonmez, M., Karakus, V., Gokmen Sevindik, O., Berber, I., Dogu, M.H., Gulturk, E., Ulas, T., Payzin, B., Kuku, I., Cagirgan, S., and Altuntas, F.

Subjects
Male, hypotension, Adolescent, adverse outcome, Turkey, Urticaria, retrospective study, very elderly, fresh frozen plasma, treatment indication, hematologic disease, morbidity, apheresis, Review, heparin, anticoagulant agent, hypocalcemia, Turkish experience, medical record review, Turkey (republic), Plasma, Therapeutic plasma exchange, experience, turkey (bird), plasma exchange, middle aged, Humans, controlled study, human, albumin, National survey, Aged, 80 and over, adult, Anticoagulants, major clinical study, mortality, Hematologic Diseases, neurologic disease, general condition improvement, aged, female, Turk (people), Blood Component Removal, pathology, history, Nervous System Diseases, metabolism
Abstract

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE. © 2019 Elsevier Ltd

Published
2019

2. The Turkish experience with therapeutic plasma exchange: A national survey

Author

Korkmaz S, Solmaz Medeni S, Demirkan F, Kalayoglu Besisik S, Altay Dadin S, Akgun Cagliyan G, Kabukcu Hacioglu S, Sari I, Goren Sahin D, Arat M, Dagdas S, Ozet G, Kutlu N, Karaagac Akyol T, Ozcebe OI, Uskudar Teke H, Kiper Unal D, Guner N, Tombak A, Celik H, Bay I, Kiki I, Ozgur G, Erkurt MA, Ozatli D, Meletli O, Demircioglu S, Demir C, Kurtoglu E, Vural F, Tobu M, Karakus A, Ayyildiz O, Dal MS, Afacan Ozturk B, Albayrak M, Ocakci S, Bolaman Z, Sonmez M, Karakus V, Gokmen Sevindik O, Berber I, and D

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Anticoagulants/*administration & dosage/adverse effects, Blood Component Removal, Female, Hematologic Diseases/metabolism/pathology/therapy, Humans, Hypocalcemia/etiology/mortality, Hypotension/etiology/mortality, Male, Middle Aged, Nervous System Diseases/epidemiology/mortality/therapy, Plasma, Plasma Exchange, Turkey/epidemiology, Urticaria/etiology/mortality
Abstract

Therapeutic plasma exchange (TPE) is used to treat more than 60 diseases worldwide and has drawn growing interest. Little is known about the current situation of TPE activity in Turkey, so we developed a survey to obtain information about this timely topic. We collected data on TPE from 28 apheresis units throughout Turkey. We performed a total of 24,912 TPE procedures with 3203 patients over the past decade. Twenty years ago, the majority of procedures were performed for neurological and hematological disorders, and today, most TPE procedures are done for the same reasons. The only historical change has been an increase in TPE procedures in renal conditions. Currently, renal conditions were more frequently an indication for TPE than rheumatic conditions. Fresh frozen plasma was the most frequently used replacement fluid, followed by 5% albumin, used in 57.9% and 34.6% of procedures, respectively. The most frequently used anticoagulants in TPE were ACD-A and heparin/ACD-A, used with 1671 (52.2%) and 1164 (36.4%) patients, respectively. The frequency of adverse events (AEs) was 12.6%. The most common AEs were hypocalcemia-related symptoms, hypotension, and urticaria. We encountered no severe AEs that led to severe morbidity and mortality. Overall, more than two thirds of the patients showed improvement in the underlying disease. Here, we report on a nationwide survey on TPE activity in Turkey. We conclude that there has been a great increase in apheresis science, and the number of TPE procedures conducted in Turkey has increased steadily over time. Finally, we would like to point out that our past experiences and published international guidelines were the most important tools in gaining expertise regarding TPE.

Published
2019

3. Platelet-rich plasma treatment improves postoperative recovery in patients with pilonidal sinus disease: a randomized controlled clinical trial.

Author

Boztug CY, Karaagac Akyol T, Benlice C, Koc MA, Doganay Erdogan B, Ozcebe OI, Kuzu MA, and Akyol C

Subjects
Adolescent, Humans, Neoplasm Recurrence, Local, Prospective Studies, Quality of Life, Pilonidal Sinus surgery, Platelet-Rich Plasma
Abstract

Background: Pilonidal sinus is a common health problem. The current study aimed to compare the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques in terms of pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure., Methods: Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled and randomly divided into three groups. Open surgery and moist dressings were applied to patients in group A. Open surgery followed by PRP application was performed on patients in group B. Group C underwent curettage of the sinus cavity followed by application of PRP. In this prospective randomized controlled study, patients completed questionnaires (including the Nottingham Health Profile (NHP), Short Form-36 (SF-36) and clinical information) before and after surgery. Demographics, preoperative characteristics, healing parameters, and quality-of-life scores were evaluated and calculated before and after surgery., Results and Conclusion: The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21. Each patient was followed up throughout the process of wound healing, and follow-up was continued afterward to monitor the patients for recurrence. Due to the nature of the treatment that group C received, this group achieved shorter healing times and smaller cavity volume than the other groups. In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups. Overall postoperative pain scores were significantly lower for both PRP groups (open surgery, group B; minimally invasive surgery, group C) than for group A (p < 0.001) and showed different time courses among the groups. In the treatment of PS disease, PRP application improves postoperative recovery in that it speeds patients' return to daily activities, reduces their pain scores and increases their quality of life. Trial registration The current study is registered on the public website ClinicalTrials.gov (ClinicalTrials.gov identifier number: NCT04697082; date: 05/01/2021)., (© 2021. The Author(s).)

Published
2021
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4. MATRA-A: A study on massive transfusion.

Author

Ünlü A, Yılmaz S, Akbasli IT, Karaagac Akyol T, Akkapulu N, Tumer M, Ertugrul Oruc N, Balas S, Goral S, Topcuoglu P, Tanriseven M, Sayin S, and Eryilmaz M

Subjects
Blood Component Transfusion, Blood Transfusion, Hospital Mortality, Humans, Plasma, Retrospective Studies, Erythrocyte Transfusion, Wounds and Injuries therapy
Abstract

Background: We use massive transfusion in various clinical conditions and it is associated with high mortality. Although some massive transfusion protocols improve patient outcomes, the clinical circumstances requiring it are not well defined., Methods: MATRA-A is a multicenter retrospective study. Six University and Training Research Hospitals in Ankara participated in the study. We collected clinical data on patients (>18 years) who received massive transfusions (≥10 units/24 h) from 2017 through 2019., Results: Overall, 167 (0·27% of transfused patients) received a massive transfusion of 2586 units of red blood cells (1·5% of total RBCs transfused). The median interquartile range values for RBCs, fresh frozen plasma (FFP) and platelets were 13 (11-176), 16 (9-33) and 4 (0-11), respectively. Surgical patients received 90% of massive transfusions. The most common clinical indications for massive transfusion were cardiovascular diseases (42·6%), trauma (20·3%) and malignancies (11%). FFP: RBC: Platelets ratio was 1·9:1:0·5. The overall and trauma-related mortality rates were 57·4% and 61·8%, respectively. The hospital mortality rates of trauma patients that received high vs. low ratio (FFP: RBCs > 1:1·5 vs. ≤1:1·5) transfusions were 47·6% and 86·6% and the difference was statistically significant (P = 0·03)., Conclusion: Cardiovascular diseases and trauma occasion are the most common causes of massive transfusion. It is infrequent in clinical settings and is associated with high mortality rates. Additionally, in massively transfused trauma patients, a high FFP:RBCs ratio seems to be associated with increased survival. Focused prospective studies are required to define the areas that need improvement on a national scale., (© 2021 International Society of Blood Transfusion.)

Published
2021
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