Plasmapheresis: Uses, Procedure, and Conditions Treated

Plasmapheresis (therapeutic plasma exchange) separates blood plasma from cellular components; plasma is treated or exchanged and returned with replacement fluid (albumin, saline, or fresh frozen plasma).

Conditions Treated (Category I–IV per ASFA Guidelines)

• Guillain-Barré syndrome (Category I).
• Myasthenia gravis (Category I/II).
• Goodpasture's syndrome (Category I).
• Thrombotic thrombocytopenic purpura (TTP) (Category I – plasma exchange is standard).
• Atypical HUS (Category I/II).
• Chronic inflammatory demyelinating polyneuropathy (CIDP) (Category II).
• Paraneoplastic syndromes (Category II/III).
• Poisoning/Overdose (protein-bound toxins, Category II/III).

Other Settings

• Pre-transplant conditioning (desensitization).
• Autoimmune/antibody-mediated diseases (ANCA vasculitis, pemphigus).
• Severe infections (remove autoantibodies/cytokines).

Procedure Overview

Central venous access → blood pumped through cell separator → plasma removed → replacement fluid infused → cells returned. Typical session: 1–2 hours, 1–1.5 plasma volumes exchanged. Course: 5–7 exchanges over 1–2 weeks.

Risks

• Hypocalcemia (citrate anticoagulation), hypotension, infection, bleeding, allergic reactions.