Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Transfusion medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Transfus Med. 2020 Jun;30(3):231-239. doi: 10.1111/tme.12666. Epub 2020 Feb 3.
Therapeutic whole blood exchange (TWBE) has been used as an alternative when methylene blue (MB) fails in severe methaemoglobinemia. However, there are limited data on the efficacy and safety of TWBE.
Our aim was to report our institutional experience with TWBE. We also perform a systematic review of published literature.
We retrospectively reviewed our respiratory intensive care unit database to identify cases of methaemoglobinemia managed with TWBE. A systematic review of the PubMed database was performed to identify similar cases (≥12 years). We report the indications, utility, and safety of therapeutic exchange in methaemoglobinemia. The procedural details were also noted.
We identified five subjects who received TWBE for methaemoglobinemia (median methaemoglobin level 39%; range 19.6-42.4%). TWBE was successful in all five cases and no adverse events were encountered. Our review identified 27 additional subjects. The median methaemoglobin level was 37.5% (range 3.7-81%). The most common indication (n = 24, 75%) for therapeutic exchange was a lack of response to MB. A majority of the subjects (n = 26/32, 81.2%) survived. No procedure-related complications were reported.
TWBE is a safe and effective salvage modality for adults with methaemoglobinemia, when MB is either contraindicated or ineffective. Future studies should standardise therapeutic exchange in the management of methaemoglobinemia.
当亚甲蓝（MB）治疗严重高铁血红蛋白血症失败时，治疗性全血置换（TWBE）已被用作替代方法。然而，关于 TWBE 的疗效和安全性的数据有限。
我们旨在报告我们机构在 TWBE 方面的经验。我们还对已发表的文献进行了系统评价。
我们回顾性地审查了我们的呼吸重症监护病房数据库，以确定接受 TWBE 治疗的高铁血红蛋白血症病例。我们对 PubMed 数据库进行了系统评价，以确定类似的病例（≥12 岁）。我们报告了 TWBE 在高铁血红蛋白血症中的适应证、效用和安全性。还记录了程序细节。
我们确定了 5 例因高铁血红蛋白血症接受 TWBE 的患者（中位数高铁血红蛋白水平为 39%；范围为 19.6-42.4%）。所有 5 例均成功进行 TWBE，未发生不良事件。我们的综述还确定了 27 例其他患者。中位数高铁血红蛋白水平为 37.5%（范围为 3.7-81%）。治疗性交换最常见的适应证（n=24，75%）是对 MB 无反应。大多数患者（n=26/32，81.2%）存活。未报告与操作相关的并发症。
当 MB 禁忌或无效时，TWBE 是成人高铁血红蛋白血症的一种安全有效的抢救方式。未来的研究应标准化 TWBE 在高铁血红蛋白血症治疗中的应用。
