Pronounced: plaz-mah-fer-EE-sis
Definition
Plasmapheresis is a
procedure that involves filtering the blood to remove the
plasma. Plasma is the liquid part of blood that contains no
cells. Once the plasma is removed, fresh plasma, or a plasma
substitute, is added back to the blood. The blood is then
returned to the body.
Plasmapheresis is
performed using an apheresis machine, also called a cell
separator. The machine works in one of two ways. It either
spins the blood at high speeds to separate the blood cells
from the plasma, or passes the blood through a special
membrane. The membrane has tiny pores that only the plasma
can pass through, leaving the blood cells behind.
Parts of the Body Involved
Reasons for Procedure
Plasmapheresis removes
autoantibodies from blood. Autoantibodies are proteins found
in plasma that mistakenly attack your body’s own tissues. In
some cases plasmapheresis is used to remove toxins or
metabolic substances from the blood.
Plasmapheresis is used
to treat the following:
-
Autoimmune diseases—conditions
that occur when the body’s immune system attacks its own
tissues and organs
-
Neurological diseases—disorders
affecting the nervous system
-
Very high levels of
cholesterol that are not reduced by diet and medications
-
Rarely used to remove
other substances
Risk Factors for Complications During the Procedure
Plasmapheresis may not
be appropriate for people with certain clotting disorders.
What to Expect
Prior to Procedure
In the days leading
up to your procedure:
The day before your
procedure:
The day of your
treatment:
-
Eat a well-balanced
meal before going for treatment, unless instructed
otherwise by your doctor.
-
Wear comfortable
clothing with sleeves that can easily be pulled
above the elbows.
-
Bring a book or a
radio with headphones to help pass the time during
the procedure.
-
Empty your bladder
before the procedure.
Anesthesia
Anesthesia is not
needed for this procedure.
Description of the Procedure
You will be asked
to lie in a bed or sit in a reclining chair. A needle
attached to a thin tube (a venous catheter) will be
inserted into each arm. Or one catheter may be inserted
into your arm and the other into the opposite foot. If
the veins in your limbs are too small to use, a long-duration
indwelling catheter will be inserted into a large vein
in your shoulder or groin area.
Long-Duration Catheter Placement in
Shoulder and Groin
© 2008 Nucleus Medical Art, Inc.
Blood will be taken
out of your body through one of the catheter tubes. It
will then go into the apheresis machine. Once separated
from the plasma, the blood cells will be mixed with
defrosted fresh frozen plasma or a plasma substitute.
The treated blood will then be returned to your body
through the other tube.
After Procedure
You will be asked
to rest for a short period of time.
How Long Will It Take?
-
A single
plasmapheresis treatment can take 1 to 3 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.
Will It Hurt?
You may experience
pain when the needles are inserted, but the procedure
itself is painless.
Possible Complications
-
Anaphylaxis—a
dangerous allergic reaction to the solutions used in
plasma replacement, which usually starts with
itching, wheezing, or a rash; the reaction can be
treated with intravenous (IV) medications.
-
Mild allergic
reaction to the procedure—may cause fever, chills,
or rash.
-
Bacterial infection—especially
a risk when a central venous catheter is used.
-
Reaction to the drug
used to keep blood from clotting—may cause muscle
cramps, and tingling or numbness in the lips or
fingertips.
-
Bleeding
complications—caused by removal of clotting agents
from the blood.
-
Drop in blood
pressure—may cause temporary light headedness,
dizziness, blurred vision, coldness, sweating, or
abdominal cramps.
-
Bruising or swelling—can
occur at the needle puncture sites.
-
Irregular heartbeat,
seizures—may occur if allergic reactions aren’t
tended to quickly enough.
-
Excessive suppression
of the immune system—the body may have difficulty
fighting off infection, due to the removal of
antibodies from the blood during treatment;
antibodies are proteins produced by the body to
fight infections.
Average Hospital Stay
-
The procedure is
usually done on an outpatient basis. In such a case,
you will be allowed to leave after a short resting
period.
-
In some instances,
hospitalization is required. Length of stay will
depend on your diagnosis.
Postoperative Care
-
Avoid hot foods or
beverages for at least two or three hours after
treatment. They dilate blood vessels and may make
you feel light-headed.
-
Avoid 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 4-6 hours after treatment.
-
You can usually
return to your regular activities the day of your
treatment.
Outcome
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 that, plasmapheresis is
mainly used as a temporary treatment.
Call Your Doctor If Any of the Following Occurs
It is essential for you
to monitor your recovery once you leave the hospital. That
way, you can alert your doctor to any problems immediately.
If any of the following occur, call your doctor:
-
Excessive bruising or
swelling at the needle puncture sites
-
Signs of infection,
including fever and chills
-
Irregular heartbeat
-
Seizures
-
Excessive itching
-
Wheezing
-
Rash
-
Nausea and/or vomiting
that you can't control with the medications you were
given after surgery, or which persist for more than two
days after discharge from the hospital
-
Pain that you can't
control with the medications you've been given
-
Cough, shortness of
breath, or chest pain
-
Abdominal pain
-
Joint pain, fatigue,
stiffness, or other new symptoms
-
Yellowish tone to your
skin
-
Yellow cast to the whites
of your eyes
-
Redness, increasing pain,
excessive bleeding, or any discharge from the incision
site
Kelly de la Rocha
is a freelance writer specializing in
parenting, food, travel, and women's issues. Her articles
have appeared in over 50 regional newspapers and magazines,
including Parenting New Hampshire, San Diego Family, and Big
Apple Parent.
RESOURCES:
Muscular Dystrophy Association
http://www.mdausa.org
Myasthenia Gravis Foundation of America, Inc.
http://www.myasthenia.org
CANADIAN RESOURCES:
Canadian Hemophelia Society
http://www.hemophilia.ca/en
Muscular Dystrophy Canada
http://www.muscle.ca/
REFERENCES:
Facts about plasmapheresis. Muscular
Dystrophy Association website. Available at: http://www.mdausa.org/publications/fa-plasmaph.html
. Accessed April 23, 2007.
Facts about plasmapheresis. Muscular
Dystrophy Association website. Available at: http://www.mdausa.org/publications/fa-plasmaph.html
. Accessed September 22, 2005.
Plasmapheresis. CHC Wausau Hospital Medical
Library and Patient Education website. Available at: http://www.chclibrary.org/micromed/00060980.html
. Accessed September 27, 2005.
Plasmapheresis. Myasthenia Gravis Foundation
of America, Inc. website. Available at: http://www.mgfaproduction.org/pe_informationalmaterials.ctm
. Accessed April 23, 2007.
Plasmapheresis. Myasthenia Gravis Foundation
of America, Inc. website. Available at: http://www.myasthenia.org/information/Plasmapheresis.htm
. Accessed September 22, 2005.
Plasmapheresis. Myasthenia Gravis Association
of Western Pennsylvania website. Available at: http://mgawpa.org/pages/plasmapheresis.htm
. Accessed April 23, 2007.
Plasmapheresis. Myasthenia Gravis Association
of Western Pennsylvania website. Available at: http://mgawpa.org/pages/plasmapheresis.htm
. Accessed September 23, 2005.
Last reviewed March 2008 by
Mark A. Best, MD, MPH, MBA
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