Plasmapheresis
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Plasmapheresis

(Plasma Exchange; Therapeutic Plasma Exchange)

Pronounced: plaz-mah-fer-EE-sis

En Español (Spanish Version)

Definition

Plasmapheresis is a procedure that involves filtering the blood to remove the plasma. Plasma is the liquid part of blood that contains no cells. Once the plasma is removed, fresh plasma, or a plasma substitute, is added back to the blood. The blood is then returned to the body.

Plasmapheresis is performed using an apheresis machine, also called a cell separator. The machine works in one of two ways. It either spins the blood at high speeds to separate the blood cells from the plasma, or passes the blood through a special membrane. The membrane has tiny pores that only the plasma can pass through, leaving the blood cells behind.

Parts of the Body Involved

  • Blood
  • Arm
  • Foot

Reasons for Procedure

Plasmapheresis removes autoantibodies from blood. Autoantibodies are proteins found in plasma that mistakenly attack your body’s own tissues. In some cases plasmapheresis is used to remove toxins or metabolic substances from the blood.

Plasmapheresis is used to treat the following:

  • Autoimmune diseases—conditions that occur when the body’s immune system attacks its own tissues and organs
  • Neurological diseases—disorders affecting the nervous system
  • Very high levels of cholesterol that are not reduced by diet and medications
  • Rarely used to remove other substances

Risk Factors for Complications During the Procedure

Plasmapheresis may not be appropriate for people with certain clotting disorders.

What to Expect

Prior to Procedure

In the days 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.

The day before your procedure:

  • 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 a radio with headphones 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. A needle attached to a thin tube (a venous catheter) will be inserted into each arm. Or one catheter 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 indwelling catheter will be inserted into a large vein in your shoulder or groin area.

Long-Duration Catheter Placement in Shoulder and Groin

Catheter

© 2008 Nucleus Medical Art, Inc.

Blood will be taken out of your body through one of the catheter tubes. It will then go into the apheresis machine. Once separated from the plasma, the blood cells will be mixed with defrosted fresh frozen plasma or a plasma substitute. The treated blood will then be returned to your body through the other tube.

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.

Will It Hurt?

You may experience pain when the needles are inserted, but the procedure itself is painless.

Possible Complications

  • Anaphylaxis—a dangerous allergic reaction to the solutions used in plasma replacement, which usually starts with itching, wheezing, or a rash; the reaction can be treated with intravenous (IV) medications.
  • Mild allergic reaction to the procedure—may cause fever, chills, or rash.
  • Bacterial infection—especially a risk when a central venous catheter is used.
  • Reaction to the drug used to keep blood from clotting—may cause muscle cramps, and tingling or numbness in the lips or fingertips.
  • Bleeding complications—caused by removal of clotting agents from the blood.
  • Drop in blood pressure—may cause temporary light headedness, dizziness, blurred vision, coldness, sweating, or abdominal cramps.
  • Bruising or swelling—can occur at the needle puncture sites.
  • Irregular heartbeat, seizures—may occur if allergic reactions aren’t tended to quickly enough.
  • Excessive suppression of the immune system—the body may have difficulty fighting off infection, due to the removal of antibodies from the blood during treatment; antibodies are proteins produced by the body to fight infections.

Average Hospital Stay

  • The procedure is usually done on an outpatient basis. In such a case, 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.

Postoperative Care

  • Avoid hot foods or beverages for at least two or three hours after treatment. They dilate blood vessels and may make you feel light-headed.
  • Avoid sun and hot weather on the day of treatment.
  • Avoid hot showers and saunas on the day of treatment.
  • 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.

Outcome

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 that, plasmapheresis is mainly used as a temporary treatment.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. If any of the following occur, call your doctor:

  • Excessive bruising or swelling at the needle puncture sites
  • Signs of infection, including fever and chills
  • Irregular heartbeat
  • Seizures
  • Excessive itching
  • Wheezing
  • Rash
  • Nausea and/or vomiting that you can't control with the medications you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you can't control with the medications you've been given
  • Cough, shortness of breath, or chest pain
  • Abdominal pain
  • Joint pain, fatigue, stiffness, or other new symptoms
  • Yellowish tone to your skin
  • Yellow cast to the whites of your eyes
  • Redness, increasing pain, excessive bleeding, or any discharge from the incision site

RESOURCES:

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

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

CANADIAN RESOURCES:

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

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

References:

Facts about plasmapheresis. Muscular Dystrophy Association website. Available at: http://www.mdausa.org/publications/fa-plasmaph.html . Accessed April 23, 2007.

Facts about plasmapheresis. Muscular Dystrophy Association website. Available at: http://www.mdausa.org/publications/fa-plasmaph.html . Accessed September 22, 2005.

Plasmapheresis. CHC Wausau Hospital Medical Library and Patient Education website. Available at: http://www.chclibrary.org/micromed/00060980.html . Accessed September 27, 2005.

Plasmapheresis. Myasthenia Gravis Foundation of America, Inc. website. Available at: http://www.mgfaproduction.org/pe_informationalmaterials.ctm . Accessed April 23, 2007.

Plasmapheresis. Myasthenia Gravis Foundation of America, Inc. website. Available at: http://www.myasthenia.org/information/Plasmapheresis.htm . Accessed September 22, 2005.

Plasmapheresis. Myasthenia Gravis Association of Western Pennsylvania website. Available at: http://mgawpa.org/pages/plasmapheresis.htm . Accessed April 23, 2007.

Plasmapheresis. Myasthenia Gravis Association of Western Pennsylvania website. Available at: http://mgawpa.org/pages/plasmapheresis.htm . Accessed September 23, 2005.



Last reviewed March 2008 by Mark A. Best, MD, MPH, MBA

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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