Plasmapheresis

Plasmapheresis is a medical procedure that removes harmful substances from your blood. It separates the liquid part of your blood, called plasma, from your blood cells. The plasma, which may contain disease-causing antibodies or proteins, is replaced with healthy fluid or donor plasma before your blood cells are returned. This treatment helps manage certain autoimmune diseases and other conditions.

What is Plasmapheresis?

Plasmapheresis is a medical procedure that cleans your blood by removing its liquid component, called plasma. This process separates your plasma from your blood cells using a special machine. The removed plasma, which often contains harmful antibodies or proteins, is then replaced with a healthy substitute or donor plasma. Finally, your treated blood cells are returned to your body.

Plasmapheresis is sometimes called plasma exchange. It works similarly to kidney dialysis, but instead of filtering waste from the blood, it specifically targets the plasma. Your blood is made of several parts: red blood cells, white blood cells, platelets, and plasma. Plasma is the yellowish, liquid portion of your blood that carries blood cells, nutrients, waste products, and important proteins throughout your body. In certain diseases, your plasma can contain harmful substances, such as abnormal antibodies or toxic proteins, that attack your own tissues. Plasmapheresis removes this problematic plasma. After separation, your blood cells are mixed with a replacement fluid, such as a salt solution (saline), a protein solution (albumin), or donor plasma, before being returned to your body. This helps to reduce the concentration of the harmful substances circulating in your bloodstream. (MedlinePlus, Mayo Clinic)

Why it's done

Plasmapheresis is performed to treat various autoimmune diseases and other conditions where harmful substances in your blood plasma cause illness. By removing this problematic plasma, the procedure helps to reduce the concentration of disease-causing antibodies or proteins. This can alleviate symptoms and prevent further damage to your body's tissues and organs, improving your overall health.

This procedure is primarily used for autoimmune diseases, where your immune system mistakenly attacks your own healthy cells. For example, in conditions like Guillain-Barré syndrome and myasthenia gravis, the body produces antibodies that damage nerves or muscle receptors. Plasmapheresis removes these harmful antibodies from your plasma. (MedlinePlus, Mayo Clinic) Other conditions treated include chronic inflammatory demyelinating polyneuropathy (CIDP), thrombotic thrombocytopenic purpura (TTP), and some kidney diseases like Goodpasture syndrome. For TTP, plasma exchange is considered a primary treatment and has significantly improved survival rates. (Mayo Clinic, Cochrane Library) By removing the harmful components, plasmapheresis aims to interrupt the disease process and allow your body to recover or stabilize. It is often used in conjunction with other medications to manage the underlying condition.

How to prepare

Preparing for plasmapheresis involves discussing your medical history and medications with your care team. You may need to stop certain blood thinners before the procedure. A healthcare provider will also ensure you have suitable access to your veins, which might involve placing a temporary catheter (central line) in a larger vein if your arm veins are not strong enough.

Before your first plasmapheresis session, your doctor will explain the procedure in detail and answer any questions you have. It is crucial to inform them about all medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements. You might be advised to temporarily stop certain medications, especially blood thinners, to reduce the risk of bleeding during the procedure. (Mayo Clinic) To allow blood to be drawn and returned efficiently, you will need good venous access. For some people, this means using veins in the arm. However, if your arm veins are small or weak, or if you need multiple treatments, a temporary catheter (a thin, flexible tube) may be surgically placed into a larger vein in your neck, chest, or groin. This central line provides a more stable and reliable access point for the procedure. (MedlinePlus, Mayo Clinic)

What happens during

During plasmapheresis, you will sit or recline comfortably as a trained clinician monitors your vital signs. Blood is drawn from a vein, typically in your arm or via a central line, and passes through a machine. This machine separates your plasma from your blood cells. The problematic plasma is discarded and replaced with healthy fluid before your blood cells are returned to your body.

The entire procedure usually takes about two to four hours, depending on the amount of plasma that needs to be exchanged. You will be able to read, watch TV, or rest during this time. The machine used for plasmapheresis is called a cell separator. It uses either centrifugation (spinning at high speeds) or membrane filtration to separate the plasma from the blood cells. (MedlinePlus) Once the plasma is separated, it is collected and discarded. Your red blood cells, white blood cells, and platelets are then mixed with a replacement fluid. This fluid can be a salt solution (saline), a protein solution called albumin, or donor plasma. The treated blood, now free of the harmful plasma components, is then returned to your body through another vein, often in your other arm or the same central line. Throughout the process, the medical team will closely monitor you for any side effects. (Mayo Clinic)

Recovery & timeline

After plasmapheresis, you may feel tired, dizzy, or lightheaded, so rest is important. Immediate recovery is usually quick, but avoid heavy lifting for a few days if a central line was used. The number and frequency of sessions vary greatly based on your condition and response, ranging from a few treatments to ongoing sessions over time.

Most people can resume their normal activities fairly quickly after a plasmapheresis session, though you might feel fatigued for the rest of the day. It's advisable to have someone drive you home after your first few treatments. If you had a central line placed, your care team will provide specific instructions on how to care for the site and when it can be removed. (Mayo Clinic) The total number of plasmapheresis treatments needed varies significantly. For acute conditions like Guillain-Barré syndrome, a typical course might involve five to seven treatments over one to two weeks. (Cochrane Library) For chronic conditions such as myasthenia gravis or CIDP, treatments might be given periodically over months or even years to manage symptoms and prevent relapses. Your doctor will determine the optimal treatment schedule based on your individual needs and how your body responds to the therapy. (MedlinePlus)

Risks & side effects

While generally safe, plasmapheresis carries potential risks and side effects. Common, mild effects include dizziness, low blood pressure, and numbness or tingling from the anticoagulant. More serious but rare risks can include infection, bleeding, allergic reactions to replacement fluids, or blood clots. Your medical team monitors you closely to minimize these complications.

Many people experience mild side effects during or immediately after the procedure. These can include a temporary drop in blood pressure (hypotension), which might cause dizziness or blurred vision. Some people also report feeling cold or experiencing numbness and tingling around the mouth, fingers, or toes. This is often due to the citrate, an anticoagulant used to prevent blood from clotting in the machine, which can temporarily lower calcium levels. These symptoms are usually managed by adjusting the treatment speed or giving calcium supplements. (MedlinePlus, Mayo Clinic) More serious complications are rare but can occur. There is a small risk of infection at the site where the needle or catheter is inserted. Bleeding can also occur, especially if you are taking blood thinners. Allergic reactions to the replacement fluids, such as albumin or donor plasma, are possible, though medical staff are prepared to manage these. Rarely, blood clots, electrolyte imbalances, or heart problems can develop. Your medical team will discuss these risks with you and take precautions to ensure your safety. (Mayo Clinic)

Success rate

The success rate of plasmapheresis varies significantly based on the condition treated. For some acute, severe autoimmune diseases like thrombotic thrombocytopenic purpura (TTP), it is a life-saving treatment with high success rates. For chronic conditions, it often manages symptoms and improves quality of life, but it may not be a cure and often requires ongoing sessions or other therapies.

Plasmapheresis has proven highly effective for several conditions. For example, in Guillain-Barré syndrome, starting plasmapheresis within seven days of symptom onset can speed recovery and reduce the need for mechanical ventilation. (Cochrane Library) Similarly, for myasthenia gravis, it can provide rapid short-term improvement, especially during a crisis or before surgery. (Cochrane Library) It's important to understand that while plasmapheresis can be very effective at removing harmful substances and alleviating symptoms, it is not always a cure. For many autoimmune conditions, it acts as a management tool, often used alongside immunosuppressant medications to control the underlying disease. The long-term success often depends on the specific diagnosis, the severity of the condition, and how consistently the treatment is administered. Your doctor will monitor your response to determine the best course of action for you. (Mayo Clinic)

Frequently asked questions

How long does a plasmapheresis session take?

A single plasmapheresis session typically takes about two to four hours. The exact duration can vary depending on your body size, the specific machine used, and the amount of plasma that needs to be processed. During this time, you will usually be seated comfortably while the medical team monitors you.

Is plasmapheresis painful?

Plasmapheresis is generally not considered painful. You might feel a brief pinch when the needle is inserted for blood access, similar to a blood draw. Some people experience mild discomfort like feeling cold, dizzy, or tingling, but these are usually manageable and not severe pain.

How many plasmapheresis treatments will I need?

The number of treatments you need varies greatly depending on your medical condition and how well you respond. For acute conditions, a course might involve 5-7 sessions over a week or two. For chronic conditions, treatments might be ongoing, spaced out over weeks or months. Your doctor will determine your specific treatment plan.

Can I eat or drink before plasmapheresis?

Your doctor or care team will provide specific instructions regarding eating and drinking before your plasmapheresis session. Generally, you can eat and drink normally, but you might be advised to avoid certain foods or drinks, like caffeine, on the day of the procedure. Always follow your clinician's guidance.

What are the alternatives to plasmapheresis?

Alternatives to plasmapheresis depend on the specific condition being treated. For many autoimmune diseases, intravenous immunoglobulin (IVIg) therapy is a common alternative or complementary treatment. Other options might include immunosuppressant medications or other targeted therapies. Your doctor will discuss the best treatment plan for your diagnosis.

Will plasmapheresis cure my condition?

Plasmapheresis is typically a treatment to manage symptoms and reduce disease activity, rather than a cure. It effectively removes harmful substances from your blood, which can lead to significant improvement and even life-saving outcomes for certain conditions. However, for many chronic diseases, it helps control the condition but does not eliminate it entirely.

Sources

• MedlinePlus — Plasmapheresis
• Mayo Clinic — Plasmapheresis
• Cochrane Library — Plasmapheresis