{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:18:26Z","timestamp":1747149506368,"version":"3.40.5"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,4]],"date-time":"2019-03-04T00:00:00Z","timestamp":1551657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>There has been an increase in the use of therapeutic plasma exchange (TPE) in immune\u2010mediated neurological disorders in recent years. However, accessibility and availability of TPE remains low and costly, especially for a country with limited healthcare funding like Malaysia. With expanding clinical indications in neurological disorders, and increasingly expensive conventional immunomodulatory treatment such as intravenous immunoglobulin and monoclonal antibodies, TPE remains an effective part of first or second\u2010line treatment. In this article, we detailed the historical aspects of the use of TPE in neurological disorders in Malaysia over the last four decades and discussed the challenges behind the establishment of the first in\u2010house neurology\u2010driven TPE service in the country. Local TPE database from a national neurology centre in Kuala Lumpur over the past 20\u2009years was analyzed. We observed a remarkable three folds increase in the use of TPE at our center over the past 10 years (total 131 TPE treatments) compared to a decade prior, with expanding clinical indications predominantly for central nervous system demyelinating disorders. Besides using membrane filtration method, centrifugal technique was adopted, providing new opportunities for other clinical beneficiaries such as a neurologist driven \u201cin\u2010house TPE unit\u201d. However, there were real world challenges, especially having to provide services with limited funding, human resources, and space. In addition, much has to be done to improve accessibility, availability, and sustainability of TPE services at our center and nationwide. Nevertheless, even with limited resources and support, it is possible with concerted efforts to work within the confines of these limitations to establish a safe, successful, and sustainable TPE service.<\/jats:p>","DOI":"10.1002\/jca.21696","type":"journal-article","created":{"date-parts":[[2019,3,4]],"date-time":"2019-03-04T10:56:18Z","timestamp":1551696978000},"page":"434-444","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The establishment of in\u2010house neurology driven therapeutic plasma exchange infrastructure in a resource\u2010limited public hospital in Malaysia: Adopting and integrating evidenced\u2010based health care technology through time"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0094-0540","authenticated-orcid":false,"given":"Shanthi","family":"Viswanathan","sequence":"first","affiliation":[{"name":"Department of Neurology Kuala Lumpur Hospital  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4708-3734","authenticated-orcid":false,"given":"Fu Liong","family":"Hiew","sequence":"additional","affiliation":[{"name":"Department of Neurology Kuala Lumpur Hospital  Kuala Lumpur Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-1101(2000)15:1\/2<74::AID-JCA6>3.0.CO;2-O"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318207b1f6"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21470_c"},{"issue":"1","key":"e_1_2_8_5_1","first-page":"60","article-title":"Plasmapheresis in clinical medicine","volume":"138","author":"Linker C","year":"1983","journal-title":"West J 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