plasmaféresis

Plasmaféresis, also known as plasma exchange or therapeutic plasmapheresis, is a medical procedure that removes a portion of the patient’s plasma from the blood and replaces it with a substitute fluid. The aim is to rapidly reduce circulating pathogenic substances—most commonly autoantibodies, immune complexes, and certain toxins—that contribute to disease activity. The process is a form of apheresis.

During the procedure, blood is withdrawn via a peripheral vein or a central venous catheter and directed into an apheresis device. Blood components are separated; plasma is discarded and replaced with 5% albumin solution or donor plasma, and the cellular components are returned to the patient. Sessions typically last one to three hours and are repeated as needed, often to replace about one plasma volume per session.

Indications include autoimmune diseases such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis crisis, immune thrombocytopenia, autoimmune hemolytic anemia, and thrombotic thrombocytopenic purpura; certain nephrological and systemic conditions with pathogenic autoantibodies; and hyperviscosity syndromes due to monoclonal proteins. It may also be used in selected cases of toxin removal or bridging therapies when rapid reduction of harmful substances is desired.

Risks include hypotension, citrate-induced hypocalcemia, bleeding, infection, and allergic reactions to replacement fluids. Access-related complications can occur with central lines. The procedure requires specialized facilities and trained staff, and not all conditions respond equally to treatment. Plasmapheresis is typically used as part of a broader therapeutic plan rather than a definitive cure.