Plasma Exchange (Plasmapheresis)
Therapeutic plasma exchange, sometimes called “plasmapheresis” (TPE or PLEX), is a procedure that can help treat rheumatic diseases such as vasculitis, systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APS), and others. These conditions are caused by abnormal antibodies that target different parts of your body and removing these antibodies from the blood can be a helpful treatment. Plasma exchange involves removing a person's blood and putting their blood into a machine where it is separated into red cells, white cells, platelets, and plasma.
Plasma, which is the liquid content of blood, is disposed of and replaced with another liquid from donors. This substitute plasma and the other blood cells are given back to the patient. Plasma contains the antibodies that can cause autoimmune diseases so removing it can help with treatment. This procedure is done in the hospital or infusion center.
How to Take It
A tube called a central venous catheter, or "central line" is placed into a large vein that leads to the heart before plasma exchange is started. When ready to use, the central line is connected to a large machine managed by a trained nurse. This central line is used to remove a person's blood and give them their blood cells and substitute plasma back after their plasma with the harmful antibodies have been removed. Each session or “round” lasts a few hours. Plasma exchange is performed every 2–3 days for a total of 5–10 sessions. Blood tests may be done before, during, or after the procedure.
Side Effects
During the procedure, a patient may feel nauseated, cold, mild tingling of the lips, hands or feet. Patients can be tired after a plasmapheresis session. If a patient has anemia, plasmapheresis can make them more anemic. Very rarely patients can feel light-headed or faint, have low calcium, vomiting, low blood pressure, or muscle cramps. Because this procedure requires a central line, there is a small risk of infection and bleeding.
Tell Your Rheumatology Provider
Fever, chills, night sweats, chest pain, headache, palpitations, numbness, tingling, muscle cramps are all reasons to contact your medical team. Redness, pain, or bleeding from the central line should be reported. Along with antibodies, plasma exchange can remove some medications, including medications you receive through an IV. The medical team should be aware of your medications and be notified of any new prescription medications, supplements, or over-the-counter medicines. Plasma exchange is safe in pregnancy. Let your medical team know if you avoid blood products.
Written February 2024 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.