Plasmapheresis (Therapeutic Plasma Exchange (TPE)) Print E-mail

The Nerve and Muscle Center offers outpatient Plasmapheresis (Therapeutic Plasma Exchange). The procedure involves the removal of plasma, which carries toxic antibodies, and replacing it with human 5% albumin. Plasma exchange is used for the treatment of various diseases including myasthenia gravis, Gullain Barre Syndrome, and chronic inflammatory immune mediated demyelinating neuropathy (CIDP). This treatment usually takes two hours and is done on an outpatient basis. The number of treatments needed varies greatly depending on the particular disease and the person's general condition and response. An average course of plasma exchanges is six to ten treatments over two to ten weeks.

During Plasmapheresis, blood is initially taken out of the body through a needle or previously implanted catheter. Plasma is then removed from the blood by a cell separator. Three procedures are commonly used to separate the plasma from the blood cells:

  • Discontinuous flow centrifugation: One venous catheter mine is required. Typically, a 300 ml batch of blood is removed at a time and centrifuged to separate plasma from blood cells.
  • Continuous flow centrifugation: Two venous lines are used. This method requires slightly less blood volume to be out of the body at any one time as it is able to continuously spin out plasma.
  • Plasma filtration: Two venous lines are used. The plasma is filtered using standard hemodialysis equipment. This continuous process requires less than 100 ml of blood to be outside the body at one time.

Each method has its advantages and disadvantages. After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma, which contains the antibodies, is first treated and then returned to the patient in traditional Plasmapheresis. (In plasma exchange, the removed plasma is discarded and the patient receives replacement donor plasma, albumin or saline with added proteins.) Medication to keep the blood from clotting (an anticoagulant) is generally given to the patient during the procedure. Plasmapheresis is used as a therapy in particular diseases. It is an uncommon treatment in the United States, but it is more common in Europe and particularly Japan.

An important use of Plasmapheresis is in the therapy of autoimmune disorders, where the rapid removal of disease-causing autoantibodies from the circulation is required in addition to slower medical therapy. It is important to note that plasma exchange therapy in and of itself is useful to temper the disease process, where simultaneous medical and immunosuppressive therapy is required for long term management. Plasma exchange offers the quickest short-term answer to removing harmful autoantibodies; however, the production of autoantibodies by the immune system must also be stopped, usually by the use of medications that suppress the immune system, such as prednisone, cyclophosphamide, cyclosporine, mycophenilate mofetil, rituximab. or a mixture of these. Other uses are the removal of blood proteins where these are overly abundant and cause hyperviscosity syndrome.



Thumbnail image Plasmapheresis Plasmapheresis Machine


Instructions for Plasmapheresis Patients


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