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Plasmapheresis

(Plasma Exchange; Therapeutic Plasma Exchange)

Definition

Plasmapheresis is done to exchange plasma in the blood. Plasma is the liquid part of the blood that does not contain cells. Once the plasma is removed, fresh plasma or a plasma substitute is added back to the blood.

Reasons for Procedure

Plasmapheresis removes autoantibodies from the blood. Autoantibodies are proteins found in plasma. They mistakenly attack your body’s own tissues. In some cases, this procedure is used to remove toxins or metabolic substances from the blood.
Plasmapheresis is used to treat the following:
  • Autoimmune diseases
  • Neurological diseases
  • Very high levels of cholesterol that are not reduced by diet and medications
  • Toxins that can get into your blood

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like
  • Anaphylaxis—a dangerous allergic reaction to the solutions used in plasma replacement, which usually starts with itching, wheezing, or a rash
  • Mild allergic reaction to the procedure, such as fever, chills, or rash
  • Infection
  • Bleeding
  • Drop in blood pressure
  • Bruising or swelling
Plasmapheresis may not be appropriate for people with certain clotting disorders.

What to Expect

Prior to Procedure

Leading up to your procedure:
  • Review your regular medications 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 noncaffeinated and nonalchoholic beverages.
The day of your treatment:
  • Eat a well-balanced meal before going for treatment, unless instructed otherwise by your doctor.
  • Wear comfortable clothing with sleeves that can easily be pulled above the elbows.
  • Bring a book or personal music player to help pass the time during the procedure.
  • Empty your bladder before the procedure.

Anesthesia

Anesthesia is not needed for this procedure.

Description of the Procedure

You will be asked to lie in a bed or sit in a reclining chair. Two needles attached to a catheter tube will be inserted into veins. In some cases, a needle will be inserted into each arm. For others, one needle may be inserted into your arm and the other into the opposite foot. If the veins in your limbs are too small to use, a long-duration catheter will be inserted. It will be placed in a vein in your shoulder or groin area.
Long-Duration Catheter Placement in Shoulder and Groin
Catheter
Copyright © Nucleus Medical Media, Inc.
Blood will be taken out of your body through one of the catheter tubes. It will then go into the apheresis machine. Once in the machine, the blood cells will be separated from the plasma. The machine works in one of two ways. In the first method, the blood cells may be separated from the plasma by spinning the blood at high speeds. The second method uses a special membrane. The membrane has tiny pores that only the plasma can pass through, leaving the blood cells behind. The blood cells will be mixed with replacement plasma or a plasma substitute. The new mixed blood will then be returned to your body through the other tube.

Immediately After Procedure

You will be asked to rest for a short period of time.

How Long Will It Take?

  • A single plasmapheresis treatment can take 1 to 3 hours.
  • The length of treatment will depend on your body size and the amount of plasma that needs to be exchanged.
  • You will most likely need to have several treatment sessions per week for two weeks or more.
  • Frequency of treatments will depend on your diagnosis.

How Much Will It Hurt?

You may experience some discomfort when the needles are inserted. The procedure itself is painless.

Average Hospital Stay

  • The procedure is usually done outside of the hospital. In such cases, you will be allowed to leave after a short resting period.
  • In some instances, hospitalization is required. Length of stay will depend on your diagnosis.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:
  • To lessen the chance of excessive bleeding, do not shave or cut your fingernails for at least 4-6 hours after treatment.
  • You can usually return to your regular activities the day of your treatment.
  • Be sure to follow your doctor's instructions.
Improvement can occur within days or weeks, depending on the condition being treated. Benefits usually last for up to several months, but may last longer. Over time, autoantibodies may again be produced by your body. Because of this, plasmapheresis is mainly used as a temporary treatment.

Call Your Doctor

Call your doctor if any of the following occurs:
  • 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
  • Feeling lightheaded, or fainting
  • Severe pain
  • Cough, wheezing, shortness of breath, or chest pain
  • Irregular heartbeat
  • Abdominal pain
  • Joint pain, fatigue, stiffness, or other new symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

Muscular Dystrophy Association http://www.mdausa.org

Myasthenia Gravis Foundation of America http://www.myasthenia.org

CANADIAN RESOURCES

Canadian Hemophelia Society http://www.hemophilia.ca

Muscular Dystrophy Canada http://www.muscle.ca

References

Facts about plasmapheresis. Muscular Dystrophy Association website. Available at: http://static.mda.org/publications/PDFs/FA-Plasmapheresis.pdf. Updated July 2005. Accessed May 24, 2013.

Muscular dystrophy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 24, 2013.

Myasthenia gravis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 7, 2013. Accessed May 24, 2013.

Plasmapheresis. Myasthenia Gravis Foundation of America, Inc. website. Available at: http://www.myasthenia.org/LivingwithMG/InformationalMaterials.aspx. Accessed May 24, 2013

Plasmapheresis. Myasthenia Gravis Association of Western Pennsylvania website. Available at: http://www.mgawpa.org/pdfs/PlasmapheresisLH.pdf. Accessed May 24, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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