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Plasmapheresis

Last updated: April 29, 2021

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Plasmapheresis is an extracorporeal process in which blood is removed from the body and then separated into plasma and blood cells. The blood cells are then returned, and depending on the procedure, the plasma may be returned after purification (selective plasmapheresis) or replaced with donor plasma or albumin solution (nonselective plasmapheresis). Some of the techniques used for purification include immunoadsorption or filtration to selectively remove certain pathogenic blood components (e.g. autoantibodies). Plasmapheresis is used for collecting plasma donations or therapeutically, including for autoimmune (e.g., myasthenia gravis, Goodpasture syndrome, Guillain-Barré syndrome), hematologic (e.g., thrombotic thrombocytopenic purpura), metabolic (e.g., severe Wilson disease), and oncologic conditions (e.g., Waldenstrom macroglobulinemia) as well as intoxications (e.g., mushroom poisoning).

Definitions

  • Apheresis: An extracorporeal process in which a patient's blood is passed through a machine that separates a particular component and returns the remaining components to the patient. Types include plasmapheresis, erythrocytapheresis, plateletpheresis, and leukapheresis.
  • Plasmapheresis: a procedure in which plasma is separated from the whole blood
  • Therapeutic plasmapheresis: plasmapheresis performed to remove harmful components of the individual's plasma (e.g., autoantibodies, toxins)

Procedure [1]

  1. A patient is connected to the plasmapheresis machine via a system of tubes.
  2. Blood is drawn from a patient.
  3. Plasma is separated from other components by either of the following:
    • Filtration: blood is filtered via a semipermeable membrane
    • Centrifugation: centrifugal forces applied to the whole blood separate blood components into layers based on their density
  4. Volume replacement is done in one of the following ways:
    • Selectively: The plasma is purified (e.g., with immunoadsorption or filtration) and returned back to the patient.
    • Nonselectively: The plasma is withdrawn and replaced with another solution (typically fresh frozen plasma or 5% albumin solution).

We list the most important complications. The selection is not exhaustive.

  1. Reeves HM, Winters JL. The mechanisms of action of plasma exchange. Br J Haematol. 2013; 164 (3): p.342-351. doi: 10.1111/bjh.12629 . | Open in Read by QxMD
  2. Padmanabhan A, Connelly‐Smith L, Aqui N, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019; 34 (3): p.171-354. doi: 10.1002/jca.21705 . | Open in Read by QxMD
  3. Youngblood SC, Deng Y, Chen A, Collard CD. Perioperative Therapeutic Plasmapheresis. Anesthesiology. 2013; 118 (3): p.722-728. doi: 10.1097/aln.0b013e3182835192 . | Open in Read by QxMD