Essential information about Plasmapheresis - often used to treat Autoimmune Disorders

Plasmapheresis is a procedure used to filter out antibodies that are mistakenly attacking the body’s own tissues. Here’s what to know about the ins and outs of the procedure.

What is Plasmapheresis?

Plasma is the liquid part of the blood. In plasmapheresis, the plasma is removed from the blood and exchanged for fresh plasma or a plasma substitute. Removing the plasma also removes abnormal antibodies or toxins or other metabolic substances that may be in the blood.

Those abnormal antibodies (called autoantibodies) are made by your body’s immune system, and they mistakenly attack your body’s own tissues. Plasmapheresis is used in treatment of autoimmune diseases like myasthenia gravis (MG) and lupus to filter out these autoantibodies. It may also be used before or after a stem cell or bone marrow transplant to "clean up the blood."

How is the Plasmapheresis Procedure Done?

Two needles attached to a catheter tube are inserted into the veins, sometimes one in each arm, sometimes one in an arm and one in a leg. This is similar to getting blood taken and requires no anesthesia. (If the veins in your limbs are too small to use, a long-duration catheter will be placed in a vein in the shoulder or groin area.)

This process can take one to three hours, depending on your body size and/or the amount of plasma that needs to be exchanged.

Most of the time, this is an outpatient procedure, which means that after the procedure is completed and you’ve had a short period of rest, you can go home. It is recommended that you come to the hospital with a friend or family member, or arrange for transportation home.

Preparing for the Plasmapheresis Procedure

The day before: 

Because blood pressure may drop during treatment, you should stay away from caffeine-containing drinks for 24 hours before the plasmapheresis. It is also a good idea to eat a well-balanced meal before the procedure. Hydration is important. Be well-hydrated before plasma-exchange by drinking 8-12 8 oz glasses of water a day and avoiding drinking alcohol before the procedure. Wear loose comfortable clothes and make sure to use the restroom before the procedure begins, because it could take 2-4 hours.

During the procedure: Some patients feel tingling or numbness in the lips or fingertips. This is caused by a medication which is added to prevent the blood from clotting while it is in the machine. The tingling or numbness can usually be quickly relieved. Some patients may feel slightly lightheaded or nauseated. This feeling is usually very brief.

After the procedure: Bruising or swelling may occur at the needle puncture site. If any of these symptoms occur and bother you, make sure you tell the medical staff, since there might be something they can do to relieve it. You should also make sure to report any unusual symptoms if they occur.

Potential Plasmapheresis Complications

Your vital signs will be monitored every 15 minutes, particularly for signs of fluid loss (volume depletion). Signs and symptoms of hypocalcemia (low levels of calcium in the blood) are also checked carefully. Hypocalcemia can cause numbness or tingling of the fingers, nose, or tongue. In children, symptoms of hypocalcemia can include abdominal pain, nausea, or vomiting.

Delayed transfusion reactions can be seen several days after the transfusion ends, and you should be alert to the signs and symptoms so that you can seek medical attention if necessary.

Sometimes an infection can occur where the catheter is placed. It is important to keep the area as clean and dry as possible.

How Often does Plasmapheresis Need To Be Done?

How often plasmapheresis is needed depends on the diagnosis and the purpose for doing it. For example, in myasthenia gravis, it is used as treatment to reduce many of the symptoms caused by the presence of the autoantibodies. In general, three to five treatments are required before most people with MG experience improvement. The number of treatments may also depend on how long the effects last, or how soon symptoms reappear.

Written By
Know Rare Team