Indications, Prescription, Laboratory Changes and Complications of Centrifugal Therapeutic Plasma Exchange in Dogs

Abstract:

Background: Therapeutic plasma exchange (cTPE) is used to treat dogs with a variety of diseases. Information regarding complication types, frequency, and associations with outcomes is limited.

Objectives: Retrospective observational study. To describe indications, demographics, prescriptions, and complications of cTPE in dogs. To evaluate associations between patient or treatment variables and clinical or laboratory abnormalities.

Methods: Medical records of dogs treated with cTPE at a university teaching hospital between 2023 and 2025 were retrospectively reviewed.

Results: Forty-six dogs underwent 66 cTPE sessions. Indications included intoxications (28 dogs) and immune-mediated diseases (IMD; 18 dogs). Treatment prescriptions averaged 1.5x the patient’s plasma volume. Replacement fluids consisted of an average of 71.3% plasma products, 13.7% artificial colloids, and 6.8% isotonic crystalloids; red blood cell–containing products were used in 43% of sessions, comprising 11.8% of replacement fluids. Complications occurred in 68.2% of sessions, most commonly urticaria or facial swelling (24.2%); all were mild to moderate and resolved with supportive care. Laboratory abnormalities occurred in 45.3% of sessions, including hypocalcemia (20.3%), hypokalemia (23.4%), and acidemia (12.5%). No patient or procedural variables were associated with complications or laboratory abnormalities. Transfusion reactions were more common in intoxication cases (P=0.036), while hypokalemia was more common in IMD cases (P=0.044). No complications were associated with mortality (15%). Conclusions and Clinical Importance: Intoxications and IMD were the most common indications for cTPE in dogs. Mild to moderate complications are frequent but not associated with mortality, supporting cTPE as a safe procedure with appropriate monitoring.