Plasmapheresis and Plasma Exchange

What is plasmapheresis and plasma exchange?

Plasma is one of four elements that make up blood, along with red and white blood cells and platelets. Plasma is mostly water containing electrolytes (dissolved salts) and proteins. Some proteins in plasma protect us from foreign substances like cancer cells, viruses, fungi and bacteria. Other proteins help control bleeding.

Plasmapheresis is the process healthcare providers use to obtain plasma from blood. Many times, providers do plasmapheresis to obtain donor plasma — plasma from healthy people that providers use when treating certain medical conditions.

Plasma exchange is when providers use plasmapheresis to replace someone’s plasma. They do that by taking blood and using a machine to separate the plasma from blood. Then, they replace the plasma with fluid, add the replacement fluid to the blood and return the blood to the person receiving treatment.

What diseases are treated with plasmapheresis or plasma exchange?

Healthcare providers use this process to treat a variety of blood disorders, neurologic disorders and blood cancers. They may use plasma exchange as a first-line or initial treatment or by combining it with other treatments. Providers may also use plasma exchange to support recovery from organ transplants.

How do healthcare providers use this treatment to treat neurologic disorders?

Providers may use plasma exchange to remove harmful antibodies from people’s plasma. Those disorders include:

• Multiple sclerosis (MS): People who have MS use plasma exchange treatment to cope with sudden, severe symptoms caused by proteins in their plasma that are attacking their body.
• Myasthenia gravis: Myasthenia gravis happens when antibodies that are supposed to attack intruders begin to attack healthy tissue. Plasma exchange filters out the abnormal antibodies.
• Guillain-Barré syndrome: This condition happens when your immune system attacks your nerves. Plasma exchange filters out the antibodies in your plasma that are attacking your immune system.

How do providers use this process to treat blood disorders?

Providers treat the following blood disorders with plasma exchange:

• Cryoglobulinemia: This condition happens when proteins called cryoglobulins clump together in your blood, clogging your arteries and causing inflammation and organ damage. Providers use plasma exchange to remove cryoglobulins that otherwise may block your arteries.
• Thrombotic thrombocytopenic purpura: People with this condition have blood clots in small arteries throughout their bodies. Providers may use plasma exchange to remove unhealthy plasma from your blood. They may use donor plasma without removing your blood.

What types of cancer are treated with plasmapheresis and plasma exchange?

• Waldenstrӧm macroglobulinemia (Lymphoplasmacytic lymphoma): This is a blood cancer that happens when lymphoid cells in your bone marrow or lymph nodes produce unusually large amounts of the antibody immunoglobulin M. Providers use plasma exchange to filter the antibody from your plasma.
• Multiple myeloma: This is a blood cancer that happens when your bone marrow produces abnormal plasma cells that become cancerous and multiply. Providers use plasma exchange to remove the abnormal plasma cells.

What happens before plasmapheresis and plasma exchange?

If you’re receiving plasma exchange, your healthcare provider may recommend you:

• Drink noncarbonated beverages, starting 72 hours before your treatment.
• Be sure to have something to eat about an hour before your treatment.
• Wear comfortable clothes and bring something to read or listen to during treatment.
• Have someone available to take you home after your treatment.

What happens during plasmapheresis and plasma exchange?

In plasmapheresis, healthcare providers obtain blood and use a machine to separate red blood cells, white blood cells, platelets and plasma to use each part of your donated blood to treat certain medical conditions.

Plasma exchange takes a few more steps:

• Providers insert a needle or intravenous line into your arm or central line catheter.
• They gradually remove small amounts of blood.
• They use a machine to separate your plasma from your blood.
• They discard your plasma.
• They combine your blood with fluid, sometimes adding a protein called albumin, and return your blood to you via intravenous line or central line catheter.

How much time does it take to do plasma exchange?

A plasma exchange may take several hours.

Is plasma exchange painful?

No, it’s not painful, but you may have some discomfort when healthcare providers place intravenous lines in your arms. Some people also have the following symptoms:

• Feeling a mild sensation of numbness or tingling.
• Feeling nauseous.
• Feeling lightheaded.
• Feeling cold.

What happens after plasma exchange?

Most people feel very tired after the procedure. Plasma is a source of hydration for your body. Your healthcare provider may recommend you drink more liquids than usual after your treatment.

What are plasma exchange benefits?

Plasma exchange is a safe and effective way to treat several neurological conditions and blood disorders, as well as ease symptoms. It also helps people who have organ transplants.

What are the risks or complications of this procedure?

Plasma exchange is a very safe procedure, but some people have the following complications during or after treatment:

• Hypocalcemia or hypomagnesemia: This condition happens when you have lower than normal calcium in your blood. The plasma exchange process may remove calcium. Providers treat this side effect with intravenous calcium.
• Hypothermia: This is low body temperature. Providers may treat this side effect by infusing (pumping) warm fluids into your body via an intravenous line.
• Hypotension: This is low blood pressure. Providers may treat this with blood, fluid or plasma transfusions.

What is the recovery time?

Most people recover from plasma exchange treatment within a few hours.

How long will I feel better after treatment?

That depends on why you’re having plasma exchange. For example, people who have myasthenia gravis may have plasma exchange to ease symptoms like weakness. They may have several treatments over a few weeks and feel stronger for a few months before needing additional treatments.

Is plasmapheresis the same as dialysis?

Dialysis and plasmapheresis and plasma exchange operate on the same principle: Filtering harmful substances from your blood. People have dialysis because their kidneys aren’t able to remove waste from their blood. That waste builds up in their bloodstream. In dialysis, providers use a machine to remove blood from your body, cleanse the blood and return it to you.

A note from Cleveland Clinic

Healthcare providers have used plasmapheresis and plasma exchange for decades. The medical practice of removing abnormal blood, including plasma, dates back centuries. Plasma exchange is part of the overall treatment for conditions including blood disorders, blood cancers and neurological diseases. Plasma exchange doesn’t cure these conditions. It does, though, ease symptoms that may affect your quality of life. If you have a condition that may be helped by plasma exchange, ask your healthcare provider for more information.