Plasmapheresis and Plasma Exchange

Overview

Plasma, one of the four main components of blood, along with red blood cells, white blood cells, and platelets, is mainly composed of water, electrolytes (dissolved salts), and proteins. These proteins play vital roles in defending the body against foreign invaders such as cancer cells, viruses, fungi, and bacteria, and also help control bleeding.

Plasmapheresis is a procedure used to extract plasma from blood. This process is often used to collect donor plasma from healthy individuals, which can be utilized to treat various medical conditions.

Plasma exchange involves using plasmapheresis to replace a person’s plasma. During this procedure, blood is drawn and passed through a machine that separates the plasma from the rest of the blood. The removed plasma is then substituted with a replacement fluid, which is mixed with the blood before being returned to the patient.

Reasons for undergoing the procedure

This procedure is used by doctors to treat blood cancers, neurological conditions, and a range of blood problems. They may combine plasma exchange with other treatments, or they could utilize it as a first-line or initial treatment. Plasma exchange is another tool that doctors might utilize to aid in organ transplant recovery.

Plasma exchange is used by providers to treat the following neurologic disorders:

In order to eliminate dangerous antibodies from patients’ plasma, doctors may employ plasma exchange. Among these illnesses are:

• Multiple sclerosis (MS): People with MS may undergo plasma exchange to manage sudden, severe symptoms caused by harmful proteins in their plasma that are attacking their body.
• Myasthenia gravis: In myasthenia gravis, antibodies meant to defend against invaders mistakenly attack healthy tissues. Plasma exchange helps by removing these abnormal antibodies.
• Guillain-Barré syndrome: This condition occurs when the immune system attacks the nerves. Plasma exchange helps by filtering out the antibodies in the plasma that are responsible for this immune attack.

Plasma exchange is used by providers to treat the following blood disorders:

• Cryoglobulinemia: This condition occurs when proteins known as cryoglobulins aggregate in the blood, leading to blocked arteries, inflammation, and organ damage. Plasma exchange is used to remove these cryoglobulins and prevent them from obstructing the arteries.
• Thrombotic thrombocytopenic purpura (TTP): Individuals with TTP develop blood clots in small arteries throughout the body. Plasma exchange is employed to eliminate unhealthy plasma from the blood, sometimes using donor plasma as a replacement without removing the patient’s own blood.

Types of cancer treated with plasmapheresis and plasma exchange

• Waldenström macroglobulinemia (Lymphoplasmacytic lymphoma): This blood cancer occurs when lymphoid cells in the bone marrow or lymph nodes produce excessive amounts of the antibody immunoglobulin M. Plasma exchange is used to filter out this antibody from the plasma.
• Multiple myeloma: This blood cancer is characterized by the production of abnormal plasma cells in the bone marrow, which become cancerous and proliferate. Plasma exchange is employed to remove these abnormal plasma cells from the blood.

Risks

Although plasma exchange is a very safe technique, some patients have the following side effects either during or following their treatment:

• Hypocalcemia: This condition is characterized by lower-than-normal blood calcium levels. The process of plasma exchange might take calcium out. This side effect is managed with intravenous calcium.
• Low body temperature (hypothermia). Doctors may address this side effect by infusing warm fluids into your body through an intravenous line. 
• Low blood pressure (hypotension). Transfusions of blood, fluid, or plasma may be used by providers to treat this.

Before the procedure

In the event that you are undergoing plasma exchange, your physician might suggest that you:

• Beginning 72 hours before to your treatment, start consuming non-carbonated beverages.
• Make sure you eat something approximately one hour prior to your procedure.
• Bring something to read or listen to during treatment, and dress comfortably.
• After your treatment, make sure someone is present to drive you home.

During the procedure

During a plasmapheresis procedure, doctors draw blood and use a machine to separate the plasma, white blood cells, red blood cells, and platelets. They then use each component of your given blood to treat certain illnesses.

A couple further stages are required for plasma exchange:

• A central line catheter or an intravenous line is inserted into your arm by healthcare professionals.
• They take out small volumes of blood gradually.
• To separate your plasma from your blood, they use a machine.
• Your plasma is discarded.
• After mixing your blood with fluid and occasionally adding albumin, they give your blood back to you through an intravenous line or central line catheter.

An exchange of plasma could take several hours.

After the procedure

After the procedure, most people feel very tired because plasma helps keep your body hydrated. Following your treatment, your doctor could advise you to consume more liquids than normal.

Outcome

After undergoing plasma exchange therapy, most patients typically recover within a few hours. 

The improvement in their condition will depend on the underlying reason for the plasma exchange. For example, in patients with myasthenia gravis, plasma exchange may help alleviate symptoms such as muscle weakness. These patients might need several treatments over a few weeks and may experience relief for a few months before requiring additional sessions.