Plasmapheresis
Overview
- Involves extracorporeal separation of blood products, resulting in filtered plasma product
- Patient's plasma is removed, blood cells re-infused, and (usually) donor plasma transfused
- In US and other high-resourced settings, separation typically done by automated centrifuge
Indications
- Established indications for plasmapheresis as first-line treatment (either alone or in conjunction with other agents)
- Indications for which plasmapheresis is accepted second-line therapy:
- Lambert-Eaton myasthenic syndrome
- Multiple sclerosis: acute CNS demyelination unresponsive to steroids
- Rapidly progressive vasculitis
- Catastrophic thrombosis due to antiphospholipid syndrome
- Acute disseminated encephalomyelitis
- Severe systemic lupus erythematosus
- Multiple myeloma cast nephropathy
- RBC alloimmunization in pregnancy
- Mushroom Poisoning
- Hemolytic uremic syndrome
- Less established, possible indications
- Thyroid storm when antithyroid drugs ineffective or contraindicated
- Pemphigus vulgaris (severe and refractory to first-line management)
- Pyoderma gangrenosum
Contraindications
- Hemodynamic instability, sepsis, or other conditions causing inability to tolerate fluid shifts
- Inability to tolerate central line placement
- Allergy to FFP or albumin
- Severe hypocalcemia (citrate anticoagulant will precipitate calcium and worsen hypocalcemia)
Equipment Needed
- Dialysis or pheresis catheter
- Central line supplies
- Automated centrifuge or semipermeable membrane
- FFP
Procedure
- See central line
- Additional steps specific to device being used to apherese, consult specialist for this!
Complications
- Transfusion reactions
- Immunosuppression
- Hypocalcemia
- Complications of central line placement