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Core Concepts in Dialysis and Continuous Therapies pp 245–256Cite as

Therapeutic Plasmapheresis

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Abstract

Therapeutic plasmapheresis or plasma exchange (TPE) is an extracorporeal therapy in which pathogen-containing plasma is selectively removed by a centrifuge or membrane and substituted for pathogen-free replacement fluid.

TPE is considered first-line therapy in a wide variety of immune-mediated diseases. The target substance is usually a pathogenic antibody and so cytotoxic therapy is often given in conjunction with TPE to halt antibody production while TPE removes circulating antibody.

Prescription of TPE is tailored to each individual patient and clinical circumstances. It involves decision-making regarding exchange volume, replacement fluid, frequency of exchanges, number of exchanges, and anticoagulation. The most commonly used replacement fluid is albumin, although saline and plasma can be utilized in certain clinical settings.

Complications are usually mild and result from central venous access complications, exposure to blood products, exposure to anticoagulants, and the procedure itself (which can be hemodynamically challenging). It is possible to perform TPE in pediatric and pregnant patients, with minor adaptations to the standard procedure.

Selective plasmapheresis techniques such as immunoadsorption and double filtration plasmapheresis are becoming increasingly popular as they minimize nonspecific depletion of plasma proteins and reduce the need for replacement fluids.

There is a need for randomized controlled trials in the field of plasmapheresis to further refine our use of this extracorporeal therapy.

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Notes

  1. 1.

    FFP is given because of the renal biopsy and the hemoptysis. If bleeding is a major concern, then more FFP and less normal saline could be prescribed.

  2. 2.

    If the patient received more FFP, more IV calcium gluconate may be required.Note: if DFPP were used, the prescription would simply ask for removal of 5.5 L plasma and replacement with small amounts of 5 % albumin (as a small amount is removed). FFP and/or fibrinogen would only be given if there were laboratory evidence of a coagulopathy.

  3. 3.

    FFP is given because it is therapeutic here.

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Authors and Affiliations

  1. Department of Nephrology, Beaumont Hospital, Beaumont Road, Dublin 9, Dublin, Ireland

    Dr. Claire Kennedy MB, BCh, BAO BMedSci & Dr. Colm C. Magee MD, MPH, FRCPI

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  1. Dr. Claire Kennedy MB, BCh, BAO BMedSci
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  2. Dr. Colm C. Magee MD, MPH, FRCPI
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Correspondence to Colm C. Magee MD, MPH, FRCPI .

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Editors and Affiliations

  1. Department of Nephrology, Beaumont Hospital, Dublin, Dublin, Ireland

    Colm C. Magee

  2. Department of Medicine/Renal Division, Brigham and Women's Hospital, BOSTON, Massachusetts, USA

    J. Kevin Tucker

  3. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

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Kennedy, C., Magee, C. (2016). Therapeutic Plasmapheresis. In: Magee, C., Tucker, J., Singh, A. (eds) Core Concepts in Dialysis and Continuous Therapies. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7657-4_20

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