Plasmapheresis (Plasma Exchange): How it works.

How does plasmapheresis work?

Plasmapheresis, or plasma exchange, is a procedure designed to remove harmful components from the blood, particularly those found in the plasma. It is often used in the treatment of autoimmune diseases, blood disorders, and neurological conditions. The process begins with drawing blood from the patient, typically through a needle in the arm. The blood is then passed through a machine that separates it into its components, including red blood cells, white blood cells, platelets, and plasma. The plasma, which contains antibodies, proteins, and other substances, is removed.

Once the plasma is removed, it is replaced with a substitute solution. This solution can be saline, albumin (a protein), or fresh frozen plasma, depending on the patient’s needs. The harmful substances in the plasma, such as autoantibodies, toxins, or abnormal proteins, are eliminated through this process. The remaining blood components, like red and white blood cells and platelets, are mixed with the replacement solution and returned to the patient.

Plasmapheresis is commonly used to treat conditions where harmful substances in the plasma are causing problems. These conditions include autoimmune diseases such as Guillain-Barré syndrome and myasthenia gravis, blood disorders like thrombotic thrombocytopenic purpura (TTP), and certain neurological disorders like chronic inflammatory demyelinating polyneuropathy (CIDP). It can also be used in cases of organ transplant rejection or in severe infections to remove toxins or antibodies.

The treatment works by removing substances that harm the body, such as autoantibodies in autoimmune diseases or abnormal proteins in blood disorders. Depending on the condition, patients may require multiple sessions of plasmapheresis over a period of time.

What risks are associated with plasmapheresis?

Plasmapheresis, while generally safe, carries some risks and potential side effects. These risks may vary depending on the patient’s overall health, the condition being treated, and the frequency of the procedure. Common risks associated with plasmapheresis include:

• Low blood pressure: Removing plasma can cause fluid shifts, leading to a drop in blood pressure. This may result in dizziness, lightheadedness, or fainting.
• Infection: The procedure often requires the insertion of a catheter, particularly for long-term treatments. This increases the risk of infection at the catheter site or in the bloodstream.
• Bleeding and clotting issues: Plasma contains important proteins involved in blood clotting. Removing plasma may lead to a temporary reduction in these clotting factors, increasing the risk of bleeding or bruising.
• Electrolyte imbalances: Replacement fluids may not perfectly match the body’s electrolyte levels, which can cause imbalances. Symptoms of electrolyte disturbances may include muscle cramps, weakness, or irregular heart rhythms.
• Allergic reactions: Some patients may have an allergic reaction to the replacement fluids, especially if fresh frozen plasma is used. This can lead to symptoms like rash, itching, or more serious reactions in rare cases.
• Nausea or vomiting: Some patients experience mild nausea during or after the procedure.
• Calcium depletion: The use of certain anticoagulants to prevent blood clotting during the procedure can lower calcium levels, leading to tingling, numbness, or muscle spasms.

In rare cases, more serious complications, such as blood clots, lung problems, or heart rhythm disturbances, can occur. However, most side effects are mild and can be managed effectively with proper monitoring and care during the procedure.