Plasma Exchange

Plasma Exchange Overview

Plasma refers to the "liquid" portion of the blood, which contains proteins, electrolytes, vitamins, hormones, etc. It does not include the red blood cells, white blood cells or platelets. Therapeutic apheresis is a procedure in which a machine separates and removes the patient's plasma.

The plasma removed from the patient must be replaced with another protein solution such as five percent human albumin (most commonly). In some cases, plasma is used from blood donors. A solution containing citrate is used to keep your blood from clotting during the treatment. About one cup of blood will be taken out of your body at any given time.

With a plasma exchange treatment, your blood will be drawn directly from a blood vessel in your arm or through a small tube (catheter) placed in a vein. The blood will be separated into plasma and blood cells (red cells, white cells, and platelets) by a centrifuge. Your plasma will be discarded while the remaining blood cells and a plasma replacement will be returned to you in your opposite arm or catheter.

How many treatments will I need?

The number of plasma exchanges needed to see improvement varies, according to the disease treated and patient response. The physician monitors the clinical response and determines the necessary number and frequency of plasma exchanges to be performed.

Is Plasma Exchange a safe procedure?

Plasma exchange is a safe procedure with approximately 300,000 exchanges performed worldwide each year with few problems, but side effects can occur.

Common side effects include fatigue, nausea, dizziness, feeling cold and tingling in the fingers and around the mouth, an allergic reaction and lowered blood pressure. It's very important to notify medical staff if these symptoms occur.

Serious complications such as abnormal heartbeat, seizures, electrolyte abnormalities and unexplained bleeding are extremely rare.

Why are Plasma Exchanges done?

A plasma exchange procedure is used when it's necessary to remove disease-causing proteins, called antibodies, from a patient. These antibodies are caused by an abnormal immune system and can attack healthy organs. It's often not possible to remove only the protein causing the disease. Therefore, the plasma must be removed to treat the illness.

What Conditions does Plasma Exchange treat?

Autoimmune Diseases including:

  • Guillain-Barré Syndrome
  • Lambert-Eaton myasthenic syndrome
  • Myasthenia gravis
  • Multiple Sclerosis
  • Macroglobulinemia (Waldenstrom's)
  • Glomerulonephritis w/anti-glomerular BM antibodies
  • Rapidly progressive glomerulonephritis
  • CIDP
  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
  • Autoimmune Encephalopathies including PANS/PANDAS."
  • Hyperviscosity syndrome
  • Thrombotic thrombocytopenic purpura (TTP)
  • Cryoglobulinemia
  • Hypertriglyceridemia

How long does the treatment take?

This can vary from patient to patient, but an average plasma exchange procedure lasts about two and a half hours.

What are the types of venous access used to do this procedure?

A dialysis catheter can be placed in several different locations and can be used for a temporary access or can be tunneled and provide for access long term. The red and blue tipped tubes containing clamps are above the skin limiting the ability for showers, swimming, etc.

Occasional peripheral intravenous access can be achieved to do this procedure but over time alternative access will be needed. Apheresis ports may be placed in the upper area of the chest bilaterally if treatments are going to be performed for a long-term basis. They are under the skin and patients can swim, shower etc., with the ports.

Are there any pre-treatment instructions?

  • Review your regular medicines with your doctor. You may be asked to stop taking some drugs.
  • Arrange to have someone drive you home from the hospital.
  • Drink plenty of non-caffeinated and non-alchoholic beverages.
  • Eat a well-balanced meal before going for treatment, unless instructed otherwise by your doctor.

Post-Treatment Instructions

  • You may feel tired after the procedure, rest and drink plenty of fluids.
  • You make now take any medications that were held prior to the treatment that your doctor has prescribed.
  • Eat a well balanced diet and do not skip meals.
  • Notify your doctor should you experience any of the following symptoms:
    • Excessive bruising, bleeding, or swelling at the needle insertion sites
    • Signs of infection, including fever and chills
    • Seizures
    • Excessive itching or rash
    • Nausea and/or vomiting
    • In case of emergency, CALL 911