Plasmapheresis

Overview

• Involves extracorporeal separation of blood products, resulting in filtered plasma product
• Patient's plasma is removed, blood cells re-infused, and (usually) donor plasma transfused
• In US and other high-resourced settings, separation typically done by automated centrifuge

Indications

• Established indications for plasmapheresis as first-line treatment (either alone or in conjunction with other agents)
  • Guillain-Barre syndrome
  • Thrombotic thrombocytopenic purpura
  • Myasthenia gravis
  • Hyperviscosity syndrome
  • Diffuse alveolar hemorrhage due to Goodpasture syndrome
  • Chronic inflammatory demyelinating polyneuropathy
  • Severe autoimmune hemolytic anemia
• Indications for which plasmapheresis is accepted second-line therapy:
  • Lambert-Eaton myasthenic syndrome
  • Multiple sclerosis: acute CNS demyelination unresponsive to steroids
  • Rapidly progressive vasculitis
  • Catastrophic thrombosis due to antiphospholipid syndrome
  • Acute disseminated encephalomyelitis
  • Severe systemic lupus erythematosus
  • Multiple myeloma cast nephropathy
  • RBC alloimmunization in pregnancy
  • Mushroom Poisoning
  • Hemolytic uremic syndrome
• Less established, possible indications
  • Thyroid storm when antithyroid drugs ineffective or contraindicated
  • Pemphigus vulgaris (severe and refractory to first-line management)
  • Pyoderma gangrenosum

Contraindications

• Hemodynamic instability, sepsis, or other conditions causing inability to tolerate fluid shifts
• Inability to tolerate central line placement
• Allergy to FFP or albumin
• Severe hypocalcemia (citrate anticoagulant will precipitate calcium and worsen hypocalcemia)

Equipment Needed

• Dialysis or pheresis catheter
• Central line supplies
• Automated centrifuge or semipermeable membrane
• FFP

Procedure

• See central line
• Additional steps specific to device being used to apherese, consult specialist for this!

Complications

• Transfusion reactions
  • Allergic transfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease (rare in plasma exchange)
  • Fluid overload
  • Sepsis
  • Transfusion infections
• Immunosupression
• Hypocalcemia
• Complications of central line placement

See Also

• Transfusion reaction