The reported incidence of complications associated with plasma exchange transfusion (TPE) varies widely depending on the definition and can be divided into two groups: those related to the procedure (17%) and those due to reactions to TPE (17%). Recent studies have found complication rates ranging from 5% to 36%, most of which were mild and did not require intervention. Hypocalcemia due to citrate anticoagulation is most common in cTPE, less common in mTPE.

In 2019, the American Society of Hemodialysis (ASFA) issued its 8th recommendation, significantly expanding the indication for TPE in many critical care conditions such as sepsis with multiple organ failure, acute liver failure, acute pancreatitis with hypertriglyceridemia, poisoning, etc. [52]. These conditions are mostly rare, so clinical trials evaluating the effectiveness of the indication are still modest. The differences in disease patterns lead to many centers having specific indications whose effectiveness has not yet been proven.

Plasmapheresis (TPE) is a blood separation method that aims to remove large molecules such as autoantibodies, immune complexes, immunoglobulins, endotoxins or lipoproteins... Removing these substances aims to improve the clinical manifestations of the disease. In addition, TPE also helps activate lymphocytes to control cytotoxicity, supplement beneficial proteins such as albumin, coagulation factors, to improve coagulation disorders[34].