Abstract
Physiological benefits of TP are being explored for various ailments. We aimed to analyse its utilization at our institute, explore clinical utility, and identify gaps. This retrospective observational analysis analysed TP procedures from 2018 to 2023. Procedure and patient details were retrieved from records and characterized as Cohort I and II for primary and secondary erythrocytosis respectively. Procedure parameters were compared between cohorts and within cohorts for pre and post-procedure parameters. Repeat procedures in patients in both the cohorts and gaps in TP requisitions, the process of TP, adverse events and follow up were also noted and analysed. Overall 272 TP were performed in 174 patients. Cohort I indications [suspected/ confirmed polycythemia vera] accounted for 21.6% of procedures and cohort II accounted for 78.3% [COPD (58.2%), post renal transplant (PRT) erythrocytosis (13.6%), congenital cyanotic heart disease (CCHD)(10.3%) and others (17.8%)]. In Cohort I, mean pre and post-procedure hemoglobin (Hb) and hematocrit (HCT), were 19.25 ± 1.62, 59.61 ± 5.26 and 17.49 ± 1.80, 53.77 ± 5.41 respectively. In Cohort II, mean pre and post-procedure Hb and HCT were 19.27 ± 1.56, 59.79 ± 5.12 and 17.45 ± 1.80, 53.81 ± 5.61 respectively. No significant difference was observed between cohorts in haematological parameters. In each cohort post-procedure Hb and HCT reduced significantly from pre-procedure Hb and HCT (p < 0.0001). Repeat procedures ranged from 2 to13. We identified missing symptoms (68.4%), diagnosis (16.5%), haematological parameters (12.2%) etc. Post-procedure parameters were available in 51.1% due to loss to follow-up. We identified secondary erythrocytosis as major indications for TP with significant gaps in TP requisitions and processes. The indications vary in different geographical distributions that emphasizes on evidence based institutional guidelines for TP. To concur on recommendations, CME, one-on-one or panel discussions with clinicians are recommended. RCTs on TP indications especially in secondary erythrocytosis is necessary to formulate strong recommendations.