What is Plasmapheresis?

What is Plasmapheresis (or plasma exchange)?

Plasmapheresis involves using a machine to separate the plasma from the rest of the blood cells. When people donate their plasma, plasmapheresis is used to obtain their plasma. Plasmapheresis can also be performed to remove a patient's plasma and replace it with a replacement fluid. This procedure is technically called therapeutic plasma exchange (TPE) or plasma exchange. Healthcare providers often use the terms plasmapheresis, TPE, and plasma exchange interchangeably to refer to the process of removing and replacing a patient's plasma.

What Diseases are Treated with Plasma Exchange?

Plasma exchange treats a wide variety of autoimmune, neurologic, and blood conditions, including, but not limited to:

• Chronic Inflammatory Demyelinating polyneuropathy (CIDP)
• Guillain-Barre Syndrome
• Multiple Sclerosis
• Myasthenia Gravis
• Neuromyelitis Optica
• Thrombotic Thrombocytopenic Purpura (TTP)
• Transplant organ rejection

In each of the above conditions, the body produces antibodies that cause harm to other cells in the body. Antibodies are typically made to attack foreign cells, but in medical conditions such as those above, the antibodies attack healthy cells and cause damage. Because antibodies are primarily contained in plasma, plasma exchange can remove these harmful antibodies and replace the patient's plasma with replacement fluid. Typically, the replacement fluid is fresh frozen plasma (FFP) or a protein-rich fluid called albumin.

What Takes Place During a Plasma Exchange Treatment?

A trained healthcare worker, usually a nurse, will set up the plasma exchange machine. A hemodialysis catheter is typically used for access in patients new to plasma exchange. Some long-term plasma exchange patients have arteriovenous fistulas, and the nurse will insert needles into the fistula for access. Once the treatment has started, it will typically last 1-3 hours. During treatment, the machine removes the patient's plasma while replacement fluid and the remainder of the patient's blood are returned to them. At the end of treatment, the patient's plasma is discarded.

What are the Benefits Of Plasma Exchange?

Plasma exchange is generally safe. Depending on the condition being treated, plasma exchange can provide symptom relief in a few days or weeks. Plasma exchange is used to improve symptoms, but it is not considered a cure for the underlying medical condition.

What are the Potential Risks of Plasma Exchange?

Low blood pressure is the most common side effect of plasma exchange, which can cause dizziness or headaches. The plasmapheresis nurse will monitor blood pressure closely and give fluid boluses if needed. Other potential risks include:

Transfusion reaction

If FFP is used as the replacement fluid, the patient will receive pre-transfusion medications such as acetaminophen, diphenhydramine, and hydrocortisone to prevent a transfusion reaction. However, transfusion reactions can occasionally occur, and the procedure may need to be paused or stopped.

Low calcium

The patient receives a sodium citrate infusion during the procedure to prevent blood clotting. Sodium citrate can reduce calcium levels, and a calcium infusion is given during the treatment to counteract this. The plasmapheresis nurse can give additional intravenous calcium if the patient experiences signs of hypocalcemia, such as muscle cramping or tingling.

Infection

Accessing the hemodialysis catheter or arteriovenous fistula inherently carries a risk of infection.

What Should You Know if Your Patient is Scheduled for Plasma Exchange while in the Hospital?

The plasmapheresis nurse may need your help with the following:

• Obtaining the prescribed medications from the pharmacy. If albumin is the prescribed replacement fluid, the plasmapheresis nurse will give the patient intravenous albumin, sodium citrate, and calcium gluconate infusions. If FFP is the replacement fluid, the plasmapheresis nurse will give pre-transfusion medications in addition to intravenous sodium citrate and calcium gluconate infusions.
• Dual blood verification for FFP. The plasmapheresis nurse will need your help performing the hospital's dual blood verification process for administering FFP. The volume of plasma exchanged is typically 4 L (or approximately 16 units of FFP), but it can be more than that depending on the patient's total blood volume.

The plasmapheresis nurse will set up the plasma exchange machine and monitor the patient during the treatment. They will notify you if there are any critical changes in the patient's status.

How Do Patients Feel after Plasma Exchange?

Many patients report feeling tired after the treatment, and this is due to the fluid shifts that happen during treatment. Symptoms typically resolve within a few hours.

How are Plasma Exchange and Hemodialysis Different?

Plasma exchange and hemodialysis both filter substances from the blood. Plasma exchange removes antibodies from the blood, while hemodialysis removes harmful waste products, such as creatinine and urea, from the blood when the kidneys are not working correctly.

References/Resources

Plasmapheresis and Plasma Exchange: Cleveland Clinic

Plasmapheresis: UC San Diego Health

Plasmapheresis: What to Expect: Healthline