What are the veterinary indications for therapeutic plasma exchange and how is it performed?

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Therapeutic plasma exchange (TPE) in dogs is indicated for immune-mediated diseases, toxicoses involving highly protein-bound substances, and hyperviscosity syndromes, with emerging use in polyradiculoneuritis and immune-mediated thrombocytopenia (IMT). In cats, TPE has been reported for acquired myasthenia gravis. 12389 --- Indications NSAID toxicosis is the best-characterized toxicological indication for TPE in dogs. TPE is particularly effective for substances with high protein binding (>80%) and low volume of distribution (<0.2 L/kg), properties shared by naproxen, ibuprofen, carprofen, and meloxicam. 5 Single-session TPE produces an 82% reduction in plasma meloxicam concentration, an 85% reduction in ibuprofen concentration, and a 51% reduction in carprofen concentration. 1 In a 62-dog multicenter cohort treated with TPE for NSAID overdose, the overall survival rate was 98.4%, and 91.1% of dogs with follow-up were not azotemic at recheck. 12 Despite 74.2% of those dogs ingesting a neurologically toxic dose, only 8% exhibited observable neurological signs during hospitalization. 12 TPE is also effective for naproxen, which carries a prolonged elimination half-life of 74 hours in dogs; a 2-plasma-volume TPE exchange produced a 46% decrease in blood naproxen concentration, and a subsequent plasmaperfusion session produced an additional 10.3% decrease. 512 Immune-mediated diseases represent the other major indication class. TPE has been applied to immune-mediated hemolytic anemia, IMT, and thymoma-associated myasthenia gravis. 349 In four dogs with IMT that were unresponsive to conventional treatment or presented with severe hemorrhage, three sequential centrifugal TPE sessions totaling 4.0–4.9 total plasma volumes per dog were associated with improvement in clinical bleeding and platelet count in three of four dogs. 9 In a cat with thymoma-associated myasthenia gravis, two TPE sessions performed 4 and 8 weeks post-thymectomy produced clinical improvement after eac