From the Guidelines
Pulmonary hemorrhage without kidney involvement is not an indication for Therapeutic Plasma Exchange (Plasmapheresis).
Indications for Plasmapheresis
- The evidence suggests that plasmapheresis is recommended for patients with severe kidney impairment (serum creatinine ≥500 μmol/L) or active vasculitis despite ongoing remission induction therapy 1.
- It is also recommended for patients with rapidly progressive severe renal disease to improve renal survival 1.
- Additionally, plasmapheresis is suggested for patients with pulmonary hemorrhage requiring mechanical ventilation 1.
- Furthermore, it is recommended for patients with an overlap syndrome of ANCA vasculitis and anti-GBM 1.
Non-Indications for Plasmapheresis
- However, for patients with pulmonary hemorrhage without kidney involvement, the harms of serious infections may outweigh the benefits, and plasmapheresis is not recommended 1.
- The decision to use plasmapheresis should be made on a case-by-case basis, considering the individual patient's risk of developing end-stage kidney disease (ESKD) and the potential benefits and harms of the treatment 1.
From the Research
Conditions Not Indicated for Therapeutic Plasma Exchange
- Rheumatoid arthritis, as stated in the study 2, where therapeutic benefit of plasma exchange was not found by controlled clinical trials
- Systemic lupus erythematosus, as mentioned in the study 2, where plasma exchange therapy was not indicated due to lack of efficacy
- Polymyositis, as noted in the study 2, where therapeutic benefit of plasma exchange was not found by controlled clinical trials
- Dermatomyositis, as stated in the study 2, where plasma exchange therapy was not indicated due to lack of efficacy
- Multiple sclerosis, although some studies 3 suggest that plasma exchange therapy can be effective in steroid-unresponsive relapses, the study 2 mentions that therapeutic benefit of plasma exchange was not found by controlled clinical trials for this condition
- Rejection of kidney allotransplant, as mentioned in the study 2, where plasma exchange therapy was not indicated due to lack of efficacy
Other Conditions
- The studies 4, 5, 3, and 6 provide information on various conditions where therapeutic plasma exchange is indicated, such as systemic vasculitis, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and autoimmune hemolytic anemia, among others. However, the question specifically asks for conditions that are not indicated for therapeutic plasma exchange.