Plasma Exchange (Plasmapheresis)

Therapeutic plasma exchange, sometimes called “plasmapheresis” (TPE or PLEX), is a medical procedure that can help treat serious complications of refractory rheumatic disease such as systemic lupus erythematous (SLE), antiphospholipid antibody syndrome (APS) and others. These conditions are caused by abnormal antibodies that target different parts of your body. Plasma exchange helps by removing these abnormal antibodies from the blood.

Plasma exchange involves removing a person's blood drawn and putting their blood into a machine where it is separated into red cells, white cells, platelets and plasma (the liquid part of blood). Plasma, which contains harmful antibodies, is discarded and replaced with a substitute fluid liquid from donors. The remaining blood components—red cells, white cells, and platelets—are returned to the patient along with the replacement fluid. Plasma exchange is typically performed in a hospital or infusion center.

How To Take It

Before starting plasma exchange, a tube called a central venous catheter (or "central line") is placed into a large vein that leads to the heart. This line allows for blood to be drawn and returned safely during treatment. The central line is connected to a specialized machine operated by a trained nurse.

Each session lasts a few hours. Plasma exchange is usually done every 2–3 days over the course of 5–10 sessions. Blood tests may be performed before, during, or after treatment to monitor your response and safety.

Possible Side Effects

During the procedure, you may feel cold, nauseated, or experience mild tingling of the lips, hands or feet. Fatigue is also common after a session. If a patient has anemia, plasmapheresis can make them more anemic. Very rarely, patients may 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 July 2025 by Howard Yang, 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.