plasmapheresis


Also found in: Dictionary, Thesaurus, Acronyms, Encyclopedia, Wikipedia.
Related to plasmapheresis: therapeutic plasmapheresis

Plasmapheresis

 

Definition

Plasmapheresis is a blood purification procedure used to treat several autoimmune diseases. It is also known as therapeutic plasma exchange.

Purpose

In an autoimmune disease, the immune system attacks the body's own tissues. In many autoimmune diseases, the chief weapons of attack are antibodies, proteins that circulate in the bloodstream until they meet and bind with the target tissue. Once bound, they impair the functions of the target, and signal other immune components to respond as well.
Plasmapheresis is used to remove antibodies from the bloodstream, thereby preventing them from attacking their targets. It does not directly affect the immune system's ability to make more antibodies, and therefore may only offer temporary benefit. This procedure is most useful in acute, self-limited disorders such as Guillain-Barré syndrome, or when chronic disorders, such as myasthenia gravis, become more severe in symptoms. In these instances, a rapid improvement could save the patient's life. Neurologic diseases comprise 90% of the diseases that could profit from plasmapheresis.

Precautions

Patients with clotting disorders may not be suitable candidates for plasmapheresis.

Description

The basic procedure consists of removal of blood, separation of blood cells from plasma, and return of these blood cells to the body's circulation, diluted with fresh plasma or a substitute. Because of concerns over viral infection and allergic reaction, fresh plasma is not routinely used. Instead, the most common substitute is saline solution with sterilized human albumin protein. During the course of a single session, two to three liters of plasma is removed and replaced.
Plasmapheresis requires insertion of a venous catheter, either in a limb or central vein. Central veins allow higher flow rates and are more convenient for repeat procedures, but are more often the site of complications, especially bacterial infection.
When blood is outside the body, it must be treated to prevent it from clotting. While most of the anticlotting agent is removed from the blood during treatment, some is returned to the patient.
Three procedures are available:
  • "Discontinuous flow centrifugation." Only one venous catheter line is required. Approximately 300 ml of blood is removed at a time and centrifuged to separate plasma from blood cells.
  • "Continuous flow centrifugation." Two venous lines are used. This method requires slightly less blood volume to be out of the body at any one time.
  • "Plasma filtration." Two venous lines are used. The pasma is filtered using standard hemodialysis equipment. It requires less than 100 ml of blood to be outside the body at one time.
A single plasmapheresis session may be effective, although it is more common to have several sessions per week over the course of two weeks or more.

Preparation

Good nutrition and plenty of rest make the procedure less stressful. The treating physician determines which of the patient's medications should be discontinued before the plasmapheresis session.

Aftercare

The patient may experience dizziness, nausea, numbness, tingling, or lightheadedness during or after the procedure. These effects usually pass quickly, allowing the patient to return to normal activities the same day.

Risks

Reinfusion (replacement) with human plasma may cause anaphylaxis, a life threatening allergic reaction. All procedures may cause a mild allergic reaction, leading to fever, chills, and rash. Bacterial infection is a risk, especially when a central venous catheter is used. Reaction to the citrate anticoagulant used may cause cramps and numbness, though these usually resolve on their own. Patients with impaired kidney function may require drug treatment for the effects of citrate metabolism.
Plasma contains clotting agents, chemicals that allow the blood to coagulate into a solid clot. Plasma exchange removes these. Bleeding complications are rare following plasmapheresis, but may require replacement of clotting factors.

Normal results

Plasmapheresis is an effective temporary treatment for:
  • Guillain-Barré syndrome (an acute neurological disorder following a viral infection that produces progressive muscle weakness and paralysis)
  • Myasthenia gravis (an autoimmune disease that causes muscle weakness)
  • chronic inflammatory demyelinating polyneuropathy (a chronic neurological disorder caused by destruction of the myelin sheath of peripheral nerves, which produces symptoms similar to Guillain-Barré syndrome)
  • thrombotic thrombocytopenic purpura (a rare blood disorder)
  • Paraproteinemic peripheral neuropathies (a neurological disorder affecting the peripheral nerves)
  • blood that is too thick (hyperviscosity)
Other conditions may respond to plasmapheresis as well. Beneficial effects are usually seen within several days. Effects commonly last up to several months, although longer-lasting changes are possible, presumably by inducing shifts in immune response.

Resources

Books

Samuels, Martin, and Steven Feske, editors. Office Practice of Neurology. New York: Churchill Livingstone, 1996.

Key terms

Anaphylaxis — Also called anaphylactic shock, it is a severe allergic reaction to a foreign substance that the patient has had contact with. Penicillin is an example of a substance that causes severe allergic reactions for some people.
Antibody — Chemicals produced by the body to defend it against bacteria, viruses, or other cells foreign to the body (antigens). Each specific antibody reacts against a specific foreign body. Antibodies are also termed immunoglobulins.
Autoimmune — Autoimmune refers to the body's development of intolerance of the antigens on its own cells.
Hemodialysis — A method to take out unwanted parts of the blood. The patient's blood is run through a catheter and tubing into a machine called a dialyzer, which filters out the unwanted blood component.
Plasma — Plasma makes up 50% of human blood. It is a watery fluid that carries red cells, white cells, and platelets throughout the body.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

plasmapheresis

 [plaz″mah-fĕ-re´sis]
the removal of plasma from withdrawn blood, with retransfusion of the formed elements into the donor; generally, type-specific fresh frozen plasma or albumin is used to replace the withdrawn plasma. The procedure may be done for purposes of collecting plasma components or for therapeutic purposes.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

plas·ma·phe·re·sis

(plaz'măf-ĕ-rē'sis),
Removal of whole blood from the body, separation of its cellular elements by centrifugation, and reinfusion of them suspended in saline or some other plasma substitute, thus depleting the body's own plasma without depleting its cells.
[plasma + G. aphairesis, a withdrawal]
Farlex Partner Medical Dictionary © Farlex 2012

plasmapheresis

(plăz′mə-fĕr′ĭ-sĭs, -fə-rē′-)
n.
A process in which plasma is taken from donated blood and the remaining components, mostly red blood cells, are returned to the donor.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

plasmapheresis

Plasma exchange  Therapeutics External shunting of plasma from the peripheral circulation, to remove an undesired substance–eg, toxins, medications–overdose, antibodies, or other 'noxins' or, less commonly, to obtain plasma for donation; pheresed fluid is resuspended in an appropriate fluid–eg, albumin or albumin in saline, then readministered to the Pt; the removal of one plasma volume–± 2500 ml effects a 65% ↓ in toxin or autoantibody in the circulation–2 volume exchanges ↓ toxin by another 20% Indications Hyperviscosity syndrome, myasthenia gravis, Eaton-Lambert syndrome, Goodpasture syndrome, post-transfusion purpura, acute Guillain-Barré syndrome, and to ↓ circulating toxins–eg, paraquat, methylparathion, mushrooms–Amanita phylloides. See Hemapheresis.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

plas·ma·phe·re·sis

(plaz'mă-fĕr-ē'sis)
Removal of whole blood from the body, separation of its cellular elements by centrifugation, and reinfusion of these elements in a suspension of saline or some other plasma substitute, thus depleting the body's own plasma without depleting its cells.
[plasma + G. aphairesis, a withdrawal]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

plasmapheresis

A method of reducing the concentration of unwanted substances, especially destructive ANTIBODIES and IMMUNE COMPLEXES in the blood. Blood is withdrawn and the cells are removed and suspended in a PLASMA substitute. It is then retransfused. The method is used mainly in such conditions as MYASTHENIA GRAVIS, GOODPASTURE'S SYNDROME and severe complicated cases of SYSTEMIC LUPUS ERYTHEMATOSUS.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
The president of PMWO, Dr Khalid Zia gave a presentation on plasmapheresis treatment in Pakistan.
With the onset of crisis, they were stopped of oral steroids and switched over to IV Methylprednisolone and then on IVIG or plasmapheresis. As per the International consensus guidance for management of myasthenia gravis by Sanders DB neurology 2016 Jul 26; 87 (4): 419-425, as well by the Cochrane database 11, 12, PLEX and IVIg are appropriately used as short-term treatments in patients with MG with life-threatening signs such as respiratory insufficiency or dysphagia; in patients with significant bulbar dysfunction; when a rapid response to treatment is needed; when other treatments are insufficiently effective; and prior to beginning corticosteroids if deemed necessary to prevent or minimise exacerbations.
The main effect of plasmapheresis is hypothesized to be the rapid decrease in levels of hypertriglyceridemia; however, an additional benefit might be the removal of excessive proteases from the plasma, which are key enzymes in inflammation, and the replacement of consumed protease inhibitors (6).
Neofytou et al., "Plasmapheresis in the management of acute severe hyperlipidemic pancreatitis: report of 5 cases," Pancreatology, vol.
The percentage of those choosing induction plasmapheresis for Scenarios B and C (roughly 35-50%) is not as high as would be expected if individuals follow or agree with the EULAR recommendations, where it is stated that plasma exchange should be considered for patients with RPGN or pulmonary hemorrhage (Statement #6, grades of evidence 1B and C, respectively) [5].
There was one report where a patient presenting with established multiorgan failure underwent ventilation, plasmapheresis, vv-ECMO, and continuous renal replacement therapy (CRRT) with extracorporeal cytokine absorbent therapy but, despite all measurements, the patient succumbed [32].
Oh et al., "Therapeutic plasmapheresis enabling radioactive iodine treatment in a patient with thyrotoxicosis," Journal of Korean Medical Science, vol.
In these patients, immunosuppressive treatment and plasmapheresis are rarely needed (2).
These include IV corticosteroids, IV immunoglobulins, plasmapheresis and immunosuppressant drugs e.g.
Abbreviations ABMR: Antibody-mediated rejection DSA: Donor-specific HLA antibodies DSAmax: DSA showing the highest MFI at the time of ABMR diagnosis DSAsum: MFI sum of all DSA exceeding 500 MFI HLAab: HLA antibody(ies) IVIG: Intravenous immunoglobulins MFI: Mean fluorescence intensity PPH: Plasmapheresis. http://dx.doi.org/10.1155/2017/6872046
Thus, neurology recommended initiating plasmapheresis, of which she completed five rounds.