Plasma Exchange (Plasmapheresis)

Plasma exchange (plasmapheresis) removes plasma from the blood and replaces it with donor plasma or albumin. This filters out harmful antibodies causing autoimmune attacks on the nervous system.

When It's Used

• Severe NMO attacks
• Steroid-resistant optic neuritis
• Severe MOGAD attacks
• Myasthenia gravis crisis
• Other severe autoimmune conditions

How It Works

• Blood removed through large IV or catheter
• Separated into cells and plasma
• Plasma containing antibodies discarded
• Cells returned with replacement fluid
• Reduces antibody levels rapidly

What to Expect

Procedure

• Large IV or central venous catheter needed
• Connected to apheresis machine
• Takes 2-4 hours per session
• 5-7 sessions typical course
• Usually inpatient

During Exchange

• Lying in bed or reclining
• Blood pressure monitoring
• May feel cold, lightheaded
• Tingling from citrate (calcium effects)

After Exchange

• May feel tired
• Monitor for bleeding
• Catheter care important

Side Effects

• Low blood pressure
• Tingling (citrate effect)
• Infection risk (catheter-related)
• Bleeding (clotting factors removed)
• Allergic reactions
• Fatigue

Effectiveness

• Can rapidly reduce antibody levels
• Effects temporary without other treatment
• Often combined with steroids and immunotherapy
• May see improvement within days

Compared to IVIG

Plasma Exchange	IVIG
Removes antibodies	Blocks antibody effects
Catheter required	IV infusion
Multiple sessions	Usually fewer sessions
Faster acting	Slightly slower