Plasmapheresis is a procedure involving the separation and removal of the plasma from the blood in order to remove a diseased substance circulating in the plasma. The red blood cells, white blood cells, and platelets are returned to the patient, along with a prescribed plasma replacement fluid. Simply stated, the “old plasma” is removed and replaced by the “new plasma.”

Plasmapheresis requires insertion of a venous catheter, either in a limb or central vein. Central veins allow higher flow rates and are more convenient for repeated procedures, but are more often the site of complications, especially bacterial infections.

A plasma exchange can help to remove harmful substances from the blood.
No special preparation is required before plasmapheresis. There is no need to fast. Patients will be given information regarding the procedure and its benefits for treatment of their condition and/or symptoms.
  • A single plasmapheresis treatment can take one to three hours.
  • The length of treatment will depend on your body size and the amount of plasma that needs to be exchanged.
  • You will most likely need to have several treatment sessions per week for two weeks or more.
  • Frequency of treatments will depend on your diagnosis and your doctor’s recommendation.
Immediately after the procedure you will be asked to rest for a short period of time. When you return home do the following to help ensure a smooth recovery:
  • Avoid hot foods or beverages for at least two or three hours after treatment. They can dilate blood vessels and may make you feel light-headed.
  • Avoid the sun and hot weather on the day of treatment.
  • Avoid hot showers and saunas on the day of treatment.
  • To lessen the chance of excessive bleeding, do not shave or cut your fingernails for at least four to six hours after treatment.
  • Most patients must stay on in the hospital because the complications may occur and the catheter must remain inserted in the patient’s vein.
  • Be sure to follow your doctor's instructions.
  • Related to vascular access
    • Hematoma
    • Pneumothorax
  • Related to the procedure
    • Hypotension from externalization of blood in the extracorporeal circuit
    • Hypotension due to decreased intravascular oncotic pressure
    • Bleeding from reduction in plasma levels of coagulation factors
    • Edema formation due to decreased intravascular oncotic pressure
    • Loss of cellular elements (platelets)
    • Ethylene oxide-associated hypersensitivity reactions
  • Related to anticoagulants
    • Bleeding, especially with heparin
    • Hypocalcemia symptoms (with citrate)
    • Arrhythmias
    • Hypotension
    • Numbness and tingling of extremities
    • Metabolic alkalosis from citrate
  • Other possible complications
    • Anaphylaxis - a dangerous allergic reaction to the solutions used in plasma replacement, which usually starts with itching, wheezing, or a rash.
    • Mild allergic reaction to the procedure - may cause fever, chills, or rash.
    • Infection
    • Bruising or swelling
    When to call the doctor?
    After you leave the hospital, contact your doctor if any of the following occurs:
  • Excessive bruising, bleeding, or swelling at the needle insertion sites
  • Signs of infection, including fever and chills
  • Seizures
  • Excessive itching or rash
  • Nausea and/or vomiting
  • Uncontrollable pain even if the medicines have been taken
  • Cough, wheezing, shortness of breath, or chest pain
  • Irregular heartbeat
  • Abdominal pain
  • Joint pain, fatigue, stiffness, or other new symptoms
  • Yellowish tone to your skin or eyes
Your doctor will provide recommendations as appropriate for your treatment.
Improvement can occur within days or weeks, depending on the condition being treated. Benefits usually last for up to several months, but may last longer. Over time, autoantibodies may again be produced by your body. Because of this, plasmapheresis is mainly used as a temporary treatment.
What if this procedure is not performed?
If your immune system is abnormal, going without this procedure may cause increased destruction of cells, which can even lead to death. If your blood is thick, going without this procedure can diminish the circulatory system and cause obstructions in the blood vessels. Please discuss all your options with your doctor.
Plasmapheresis may not be appropriate for people with certain blood clotting disorders, patients in the state of shock or hypotension.
An alternative to plasmapheresis is a human immunoglobulin for intravenous administration, depending on the patient’s illness.

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