Plasmapheresis (Plasma Exchange)

Plasmapheresis (also called plasma exchange or PLEX) is a treatment that removes harmful antibodies from the blood. It's used for severe autoimmune conditions where the immune system attacks the body's own tissues, including conditions affecting the eyes and nervous system.

How It Works

The Process

1. Blood is drawn from a vein (or catheter)
2. Blood passes through a machine
3. Plasma (liquid portion containing antibodies) is separated
4. Plasma is discarded and replaced with:
   • Albumin solution, or
   • Donor plasma
5. Blood cells are returned to the patient

Why It Helps

By removing plasma, the procedure removes:

• Pathogenic antibodies
• Complement proteins
• Other inflammatory factors

This provides rapid improvement while other treatments take effect.

Conditions Treated

Neuromyelitis Optica (NMO)

• For severe attacks
• When IV steroids insufficient
• See NMO

Severe Optic Neuritis

• When steroids don't work
• In NMO or MOGAD
• Not typically used for MS-related optic neuritis

Myasthenia Gravis

• For myasthenic crisis
• Severe weakness affecting breathing/swallowing
• Before surgery (thymectomy)
• See Myasthenia Gravis

Other Conditions

• Guillain-Barré syndrome
• Chronic inflammatory demyelinating polyneuropathy (CIDP)
• Certain autoimmune encephalitis cases

The Procedure

Preparation

• Blood tests to check baseline values
• May need central venous catheter placed
• Review of medications

During Treatment

• Each session takes 2-4 hours
• Usually done in hospital or specialized center
• You lie in a bed/recliner
• Connected to apheresis machine
• Blood flows through the machine and back to you

Treatment Schedule

• Typically 5-7 sessions
• Usually every other day
• Some protocols vary

Monitoring

• Blood pressure checked frequently
• Calcium levels monitored
• Watch for reactions

What to Expect

During Sessions

• May feel cold (receiving room-temperature fluids)
• Possible tingling (from citrate anticoagulant—low calcium)
• Light-headedness
• Fatigue afterward

After Sessions

• Usually can go home same day (if outpatient)
• May feel tired
• Improvement may be noticed after a few sessions

Side Effects and Risks

Common

• Fatigue
• Tingling around mouth or fingers (low calcium)
• Muscle cramps
• Dizziness or lightheadedness
• Nausea

Less Common

• Low blood pressure
• Allergic reactions
• Infection (especially with central line)
• Bleeding (clotting factors removed)

Rare

• Severe allergic reaction
• Blood clots
• Catheter complications

Effectiveness

How Quickly It Works

• Faster than other immunotherapies
• Some improvement within days
• Maximum effect after completing course

How Long It Lasts

• Temporary—antibodies are produced again
• Effect wears off over weeks
• Usually combined with other treatments for lasting benefit

Compared to Other Treatments

vs. IV Steroids

Feature	Plasmapheresis	IV Steroids
Speed of action	Faster	Fast
How it works	Removes antibodies	Reduces inflammation
Duration of effect	Temporary	Temporary
Side effects	Different profile	Steroid side effects

vs. IVIG

• IVIG adds modulating antibodies
• Plasmapheresis removes antibodies
• Sometimes used in sequence
• See IVIG

Practical Considerations

Access

• Requires specialized center
• May need hospital admission
• Not available everywhere

Cost

• Expensive treatment
• Usually covered by insurance for approved indications
• Prior authorization often required

Time Commitment

• Multiple sessions over 1-2 weeks
• Each session 2-4 hours
• Travel to treatment center

Frequently Asked Questions

Is plasmapheresis painful?

The procedure itself is not painful, though needle insertion may cause brief discomfort. Some people experience tingling from calcium changes.

Will I need this treatment again?

Possibly. If you have a chronic condition, you may need plasmapheresis for future flares or attacks.

Can I drive after a session?

It depends on how you feel. Many people feel fatigued and may need someone to drive them home, especially after the first session.

How does this differ from dialysis?

Dialysis filters waste products from the blood (for kidney failure). Plasmapheresis removes plasma containing antibodies. Different processes for different conditions.