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Plasmapheresis - Procedure, Advantages, Risks and Complication

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Plasmapheresis is a procedure that separates blood plasma from blood cells for treating various diseases. Read this article to learn more about plasmapheresis.

Medically reviewed by

Dr. Abdul Aziz Khan

Published At January 12, 2023
Reviewed AtJanuary 10, 2024

What Is Plasmapheresis?

Plasmapheresis is a scientific procedure where the blood plasma is segregated from the blood cells. In particular, another solution, such as saline or albumin, is used to replace plasma or the plasma is treated externally and then returned to the body.

If the patient is sick, antibodies in their plasma may attack the immune system. The affected plasma is then replaced by a machine with good plasma or a plasma substitute. This procedure is also known as plasma exchange.

Plasmapheresis can also be referred to as the process of donating plasma. Here, the blood plasma is removed from the patient’s body, and the blood cells are returned to the body.

When Plasmapheresis Is Required?

Plasmapheresis is a medical procedure that is usually preferred to manage various chronic autoimmune disorders, including:

The body has produced antibodies (proteins) programmed to identify cells in these disorders and destroy them. These antibodies are present in the blood plasma. However, in normal conditions, these antibodies are directed at foreign antigens, such as a virus, that may cause damage to the body. Plasmapheresis is implicated in stopping this process by replacing the affected plasma containing antibodies with the new plasma.

The therapy is also used to treat patients who are severely ill with fatal infections and other disorders, such as Wilson’s disease (a disease characterized by excessive copper accumulation in the organs) and thrombotic thrombocytopenic purpura (life-threatening blood disease where blood clots are formed in the small blood vessels throughout the body). Plasmapheresis has also been used in patients who have undergone organ transplants to counteract the natural rejection process of the body.

What Happens In Plasmapheresis Therapy?

During this therapy, the patient will be made to lie down. A needle or catheter is inserted into a vein of the patient. The replaced or treated plasma flows into the body through a second tube attached to the arm or foot.

People can usually donate plasma up to two times a week; the donation sessions are usually 90 minutes. The procedure usually lasts between one and three hours in the case of plasmapheresis therapy. As many as five treatments per week may be required by the patient. However, the treatment frequency varies widely from condition to condition and depends on the patient's overall health.

How To Prepare the Patient for Plasmapheresis?

To minimize the symptoms and risks of the procedure, the following measures should be taken;

  • Patients should be provided with a nutritious, balanced diet before the therapy or plasma donation.

  • Proper night's sleep before the procedure.

  • Drink lots of fluids.

  • Get vaccinated for common infections before undergoing therapy.

  • Avoid smoking, tobacco, and alcohol consumption.

  • The diet to be consumed should be rich in protein and low in phosphorus, sodium, and potassium before the procedure of plasmapheresis.

What Are the Advantages of Plasmapheresis?

The patient gets relieved after receiving plasmapheresis as a treatment for some serious infection or an autoimmune disease. However, plasmapheresis will only provide short-term symptomatic relief. The process needs to be repeated many times a week also. The frequency and outcome of the results largely depend on the patient's condition and the disease's severity. The healthcare professional will provide a general idea of plasmapheresis to the patient.

What Are the Risks and Complications of Plasmapheresis?

Plasmapheresis has got a few side effects. However, they are usually mild and rarely present. The most frequently found complication is a decrease in blood pressure. This symptom is usually accompanied by:

  • Lightheadedness (faintness).

  • Impaired vision for a few weeks (blurry).

  • Dizziness (vertigo).

  • Feeling cold.

  • Abdominal cramps.

  • Risk of encountering serious infections.

  • Blood coagulation (the doctor usually prescribes anticoagulants to prevent this risk).

  • Hypersensitivity reaction (allergic reactions).

  • Profuse bleeding can be a more serious risk from consuming anti-coagulants.

  • Seizures.

  • Tingling and numbness in the limbs.

Plasmapheresis is not advisable in patients including:

  • People who are not stable hemodynamically.

  • People who have allergies to heparin.

  • People with hypocalcemia (reduced calcium levels in the serum).

  • People who have allergies to frozen plasma or frozen plasma protein albumin.

Conclusion

Plasmapheresis is the therapeutic procedure of removing, treating, and returning or replacing blood plasma or components from and to the circulating blood of the person. Therefore, it is an extracorporeal therapy (a medical procedure performed outside the body). It is usually employed to lower the concentration of immune complexes or decrease the titer of autoantibodies that may cause damage to several body organs. Research and efforts are being made to make this medical procedure a useful adjunct to chemotherapy for removing immunoglobulin proteins in tumors like multiple myeloma.

Frequently Asked Questions

1.

What Is the Maximum Number of Plasmapheresis Treatments a Patient Can Undergo?

The maximum number of plasmapheresis treatments a patient can undergo typically depends on their specific medical condition and the treatment plan recommended by their healthcare provider. It can vary widely, ranging from a single treatment to multiple sessions over an extended period. The decision is made after a thorough evaluation of the patient's needs and the effectiveness of the treatment in addressing their condition.

2.

What Specific Parameters Should Be Monitored Post-Plasmapheresis?

After a plasmapheresis procedure, it is essential to monitor various parameters, including vital signs, blood pressure, and levels of specific blood components. This monitoring helps ensure the patient's safety and provides valuable information on the procedure's effectiveness and any potential side effects. The specific parameters to be monitored will be determined by the healthcare provider based on the patient's condition and the purpose of the plasmapheresis.

3.

What Is the Expected Time Frame for Observing Results Following a Plasmapheresis Procedure?

The timeframe for observing results following a plasmapheresis procedure can vary depending on the patient's medical condition and the therapeutic goals. In some cases, immediate improvements may be noticeable, while in others, it may take several days or even longer to see significant changes. It is essential for patients to discuss their expected timeline with their healthcare provider, as it will be tailored to their specific situation.

4.

What Post-Plasmapheresis Outcomes Should One Anticipate?

Post-plasmapheresis, one should anticipate a range of outcomes, which can include symptom relief, improved blood component levels, and potential reduction in disease activity. However, the exact results can vary widely depending on the patient's condition and the goals of the plasmapheresis treatment. It's crucial to have realistic expectations and maintain ongoing communication with the healthcare provider for a better understanding of the anticipated outcomes in a specific case.

5.

How Much Plasma Is Typically Extracted During a Plasmapheresis Session?

During a plasmapheresis session, the amount of plasma typically extracted can range from 200 to 600 milliliters, but this can vary based on the patient's condition and the specific treatment plan. The exact volume of plasma removed will be determined by the healthcare provider to ensure the patient's safety and the effectiveness of the procedure in addressing their medical needs.

6.

What Volume of Blood Is Typically Withdrawn During Plasmapheresis?

The volume of blood withdrawn during a plasmapheresis procedure typically ranges from 400 to 800 milliliters, but this can vary depending on the patient's condition and the specific treatment plan. The healthcare provider will determine the appropriate volume to be withdrawn to achieve the therapeutic goals while maintaining the patient's safety and well-being.

7.

Does Plasmapheresis Completely Eliminate Antibodies From the Bloodstream?

Plasmapheresis may significantly reduce the levels of antibodies in the bloodstream, but whether it removes all antibodies depends on the specific procedure and the patient's condition. In some cases, plasmapheresis can effectively target and eliminate specific antibodies or harmful substances, while leaving other antibodies unaffected. The extent to which all antibodies are removed should be discussed with the healthcare provider, as it can vary based on individual circumstances.

8.

Are Platelets Removed as Part of the Plasmapheresis Process?

Platelets are not typically removed as part of the plasmapheresis process. Plasmapheresis primarily focuses on the extraction and replacement of plasma components, such as antibodies and other proteins, rather than blood cells like platelets. This is a key distinction in the procedure to ensure that essential blood components are not depleted.

9.

What Type of Vascular Access Is Required for Plasmapheresis?

For plasmapheresis, a vascular access line is required. This is usually established through the insertion of a central venous catheter or a specialized access device, which allows for the safe and efficient removal and reinfusion of blood components during the procedure. The specific type of access required may vary depending on the patient's condition and the treatment plan, and it will be determined by the healthcare provider.

10.

Can Plasmapheresis Have an Impact on Blood Pressure?

Plasmapheresis can potentially have an impact on blood pressure. During the procedure, the removal and replacement of plasma components can affect the overall volume and composition of the patient's blood. This may lead to fluctuations in blood pressure, and it's essential for healthcare providers to monitor and manage these changes to ensure the patient's safety and well-being during the plasmapheresis session.

11.

Is Anemia a Potential Side Effect of Plasmapheresis?

Anemia is a potential side effect of plasmapheresis. The procedure involves the removal of blood components, including red blood cells, which can lead to a temporary decrease in the patient's red blood cell count. This reduction in red blood cells may result in anemia, causing symptoms like fatigue and weakness. However, healthcare providers take measures to minimize the risk and closely monitor the patient's blood levels during and after the procedure.

12.

Does Plasmapheresis Result in an Increase in White Blood Cell (WBC) Count?

Plasmapheresis typically does not result in an increase in white blood cell (WBC) count. The procedure primarily focuses on the removal and replacement of plasma components, such as antibodies and proteins, rather than blood cells like white blood cells. Therefore, the white blood cell count is generally not significantly affected by plasmapheresis. However, any changes in white blood cell count should be monitored and evaluated by healthcare providers as part of the overall patient assessment.

13.

Why Is Calcium Administered During the Course of Plasmapheresis?

Calcium is administered during plasmapheresis to prevent a condition known as hypocalcemia, which can occur when plasma is removed. Hypocalcemia is characterized by low levels of calcium in the blood and can lead to symptoms like muscle twitching, numbness, and tingling. By administering calcium, healthcare providers aim to maintain the patient's blood calcium levels within a normal and safe range during the plasmapheresis procedure.

14.

Is It Permissible to Eat During a Plasmapheresis Session?

During a plasmapheresis session, it is generally not permissible to eat. Patients are typically advised to fast for a certain period before the procedure to minimize the risk of side effects. Fasting helps ensure that the blood components targeted for removal during plasmapheresis are not affected by dietary intake. Patients should follow the specific instructions provided by their healthcare provider regarding eating and fasting before and during the procedure.

15.

Is Albumin Extracted During the Plasmapheresis Procedure?

Albumin is not typically removed during the plasmapheresis procedure. Plasmapheresis primarily targets the extraction and replacement of plasma components, such as antibodies and proteins, while preserving essential blood proteins like albumin. This is done to maintain the overall stability and functionality of the patient's blood. The removal of albumin is generally not a primary objective of plasmapheresis.

Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology

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plasmapheresis
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