Plasmapheresis: Types, Procedure, Indications, Side-Effects, Complications

Plasmapheresis is an extracorporeal procedure which means it is a procedure that occurs outside of the body in which the blood plasma is extracted from the blood stream and is exchanged or treated and is then returned back to the blood circulation. It is quite a broad term that includes a variety of procedures in which blood is extracted from the body, only to return back to it.

Plasmapheresis technique was first used by Michael Rubinstein when he used plasmapheresis to save the life of a boy suffering from Thrombotic Thrombocytopenic Purpura (TTP) at Lebanon Hospital of Los Angeles in 1959. The word plasmapheresis is a mixture of two Greek words-

Plasma- which means something molded or created and

Aphairesis- which means taking away.

Plasmapheresis technique is used to cure a variety of auto-immune disorders such as Goodpasture’s syndrome, myasthenia gravis, Guillain–Barré syndrome and lupus etc.

There are basically three types of plasmapheresis techniques that are usually applied for various diseases-

In this type of plasmapheresis, blood plasma is removed from a patient and then treated outside a person’s body in some way and then it is returned back to the patient. In this plasmapheresis procedure, blood plasma is not replaced by someone else’s blood plasma. Instead it is treated to make it better compatible for the patient.

In this technique of plasmapheresis, after the blood is removed from the body, its components are separated. Blood Corpuscles from this type of plasmapheresis are returned to the body while the plasma is removed. This removed plasma is usually frozen and stored for use in the preparation of various medicines or as fresh frozen plasma.

Plasma Therapy (PE) or Plasma Exchange Therapy (PET) is a plasmapheresis procedure in which blood is removed from the patient and then its components are separated. Blood cells are returned to the body while the blood plasma is discarded. Instead, patient receives blood plasma of some other donor. Sometimes serum albumin proteins or a mixture of saline solution and albumins are also administered to the patient.

The procedure of plasmapheresis is actually quite simple and mainly includes three steps-

1. Removal of blood from the body of the patient which is usually done through a needle or a catheter.
2. Separation of blood plasma and the blood cells from each other using a variety of procedures.
3. And returning the blood plasma and cells to the body of the patient.

In the third step of plasmapheresis technique, blood cells are returned as it is while the blood plasma is first treated to remove antibodies which are produced in auto-immune disorders against one’s own body, and then the blood plasma is also given back to the patient.

For the separation of the blood cells from the blood plasma in plasmapheresis technique, three different types of procedures are commonly employed-

In this only one line of venous catheter is used and the blood is removed in batches of 300ml each. Centrifugation is then done to separate blood plasma from the cells.

In this process, two separate venous catheter lines are used and the blood plasma is continuously churned out and returned to the body through the second venous line while the first removes blood from the body.

In this procedure blood plasma is separated in the same manner as a hemodialysis procedure. In this also, two venous lines are required and only 100ml of blood is extracted at a time.

Plasmapheresis is used to treat a variety of diseases such as Idiopathic pulmonary fibrosis, Guillain–Barré syndrome, Miller Fisher syndrome, Chronic inflammatory demyelinating polyneuropathy, Goodpasture’s syndrome, Myasthenia gravis, Thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome, Granulomatosis with polyangiitis, Lambert-Eaton syndrome, Antiphospholipid antibody syndrome (APS or APLS), Microscopic polyangiitis, Recurrent focal and segmental glomerulosclerosis in the transplanted kidney and Hyperviscosity syndromes such as Cryoglobulinemia, Paraproteinemia, Waldenström macroglobulinemia etc.

Actually the diseases that can be treated with the use of plasmapheresis technique can be broadly classified into following groups-

First and foremost are the auto-immune disorders as the technique of plasmapheresis is most useful in this type of disorders. In these types of diseases, body starts producing antibodies against its own cells and tissues. This is due to an abnormal immune system. Plasmapheresis is used to remove excess antibodies.

This plasmapheresis technique is also useful in treating neurological disorders such as myasthenia gravis.

Plasmapheresis is also useful in removing proteins from the blood when they are present in a very high quantity in blood leading to various diseases such as hyperviscosity syndromes.

High levels of toxins in blood can lead to various diseases. These toxins can also be removed from the blood with the use of plasmapheresis technique.

Very high levels of cholesterol in blood can also be reduced with the use of plasmapheresis but this should only be done when all other conventional methods such as medicine and diet fail.

Even though the process of plasmapheresis is quite effective, it can also lead to some side-effects and complications. Some of these are as follows-

Plasmapheresis can lead to hypotension. Blood pressure gets reduced after plasmapheresis process. Hypotension is a side-effect related with all extracorporeal procedures.

The immunity of the body is reduced in plasmapheresis. This is due to the fact that a high number of antibodies are removed from the blood during the procedure of plasmapheresis which can lead to suppressed immune system. That is one of the side-effect of the plasmapheresis procedure.

One of the complications of the plasmapheresis process is anaphylaxis. It is a type of very dangerous allergic reaction to the solutions used during the procedure of plasmapheresis. Apart from this, common allergic reactions can also occur due to the process of plasmapheresis. They are usually characterized by itching, rashes and wheezing.

One other complication of the procedure of plasmapheresis is the formation of clots. When the blood is removed from the body, it clots when it comes in contact with the plasmapheresis machine. To stop this, sodium citrate and other anti-coagulants are mixed in blood which binds with calcium and since calcium is essential for clotting of blood, this helps in eradicating the problem of clotting. But this may lead to the problem of very low calcium level in blood which can prove lethal for the patient.

Since in the plasmapheresis process, catheter and needles are inserted inside the body, they can lead to various infections. This complication can also occur because sometimes the patient also receives blood plasma from other people which can also lead to transfusion related infections.

Bleeding or hematoma can also occur due to plasmapheresis procedure. This side-effect of bruising, bleeding and hematoma occurs due to needle placement.

For the process of plasmapheresis, patients and doctors should take following precautions-

• Patients should follow all of the instructions given by their doctor before and after the plasmapheresis procedure.
• If the calcium levels get reduced during the plasmapheresis process, calcium should be given to the patient intravenously. It can also be given orally.
• All the equipment and tools should be sterilized and the plasmapheresis procedure should be done in extremely aseptic conditions so as to reduce the chances of infection.
• Blood plasma that is being donated to the patient during plasmapheresis process should be tested first for the presence of various pathogens.
• Patients should avoid hot foods, hot baths, sun bathing etcetera for the first few hours after the plasmapheresis procedure as it can dilate blood vessels resulting into hypotension and making you light headed.
• Do not do anything that may result into an injury such as shaving etc. as it can lead to excessive bleeding.

You have to understand that just like any other medical procedure plasmapheresis; although quite beneficial in a lot of diseases and disorders, is not without its fair share of complications and adverse effects. But if you consult a good and trained doctor and follow all the instructions given by him or her, there is no reason why you can’t go through plasmapheresis process relatively safely.

Also Read:

• Guillain-Barré Syndrome: Treatment, Symptoms, Causes
• Goodpasture’s Syndrome or Anti-GBM Disease: Causes, Symptoms, Treatment- Plasmapheresis
• Myasthenia Gravis: Causes, Signs, Symptoms, Investigations, Treatment- Medications, Surgery
• Waldenstrom Macroglobulinemia: Causes, Symptoms, Diagnosis, Treatment, Complications
• What Causes Solar Urticaria and How Can it Be Treated?