Abstract：
BACKGROUND: Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region.
METHODS: A questionnaire-based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center.
RESULTS: A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add-on treatment in steroid-refractory cases or as first-line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post-TPE relapse rates, and TPE-related complications. The major challenges within our region are expense, reimbursibility, and access to TPE.
CONCLUSIONS: Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.
METHODS: A questionnaire-based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center.
RESULTS: A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add-on treatment in steroid-refractory cases or as first-line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post-TPE relapse rates, and TPE-related complications. The major challenges within our region are expense, reimbursibility, and access to TPE.
CONCLUSIONS: Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.
摘要：
背景：治疗性血浆置换（TPE）在东南亚地区发挥了重要作用。这项研究调查了在该地区进行TPE的挑战。
方法：2021年1月对来自7个国家的15名东南亚治疗性血浆置换联盟（SEATPEC）成员进行了问卷调查。它包括人口统计，TPE技术,适应症,挑战,定时,结果测量，并在每个当地中心进行实验室测试。
结果：共纳入来自12个参与中心的15名神经科医师。他们通常进行五次TPE(100.0%)，血浆体积为1至1.5（93.3％），和通过中心导管交换（100.0％）。视神经脊髓炎谱系障碍和重症肌无力的急性复发是最常见的适应症。他们使用生理盐水和5％白蛋白（60.0％）的组合作为替代液。大多数（66.7％）使用TPE作为类固醇难治性病例的附加治疗或作为严重发作的一线治疗。他们建议通过下一次发作的间隔时间来评估TPE的疗效，TPE后复发率，和TPE相关并发症。我们地区的主要挑战是费用，报销，和访问TPE。
结论：尽管各国之间存在差异，所有人在方法上都有相似之处，适应症,定时,障碍,以及TPE对神经免疫疾病的挑战。区域合作对于确定减少未来获得TPE的这些障碍的战略至关重要。
方法：2021年1月对来自7个国家的15名东南亚治疗性血浆置换联盟（SEATPEC）成员进行了问卷调查。它包括人口统计，TPE技术,适应症,挑战,定时,结果测量，并在每个当地中心进行实验室测试。
结果：共纳入来自12个参与中心的15名神经科医师。他们通常进行五次TPE(100.0%)，血浆体积为1至1.5（93.3％），和通过中心导管交换（100.0％）。视神经脊髓炎谱系障碍和重症肌无力的急性复发是最常见的适应症。他们使用生理盐水和5％白蛋白（60.0％）的组合作为替代液。大多数（66.7％）使用TPE作为类固醇难治性病例的附加治疗或作为严重发作的一线治疗。他们建议通过下一次发作的间隔时间来评估TPE的疗效，TPE后复发率，和TPE相关并发症。我们地区的主要挑战是费用，报销，和访问TPE。
结论：尽管各国之间存在差异，所有人在方法上都有相似之处，适应症,定时,障碍,以及TPE对神经免疫疾病的挑战。区域合作对于确定减少未来获得TPE的这些障碍的战略至关重要。
