Editing Plasmapheresis (section)

== Medical uses ==
During plasmapheresis, [[blood]], which consists of [[blood cell]]s and a clear liquid called [[blood plasma]], is initially taken out of the body through a needle or previously implanted [[catheter]]. Plasma is then removed from the blood by a cell separator. Three procedures are commonly used to [[blood fractionation|separate]] the plasma from the blood cells, with each method having its own advantages and disadvantages:<ref name="reimann1990">{{cite journal |last1=Reimann |first1=P. M. |last2=Mason |first2=P. D. |title=Plasmapheresis: Technique and complications |journal=Intensive Care Medicine |date=January 1990 |volume=16 |issue=1 |pages=3–10 |doi=10.1007/BF01706318 |url=https://link.springer.com/article/10.1007/BF01706318 |access-date=5 January 2025|url-access=subscription }}</ref>
* Discontinuous flow [[centrifugation]]: One venous catheter line is required. Typically, a 300 ml batch 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 out of the body at any one time, as it is able to continuously spin out plasma.
* Plasma [[filtration]]: Two venous lines are used. The plasma is filtered using standard [[hemodialysis]] equipment. This continuous process requires that less than 100 ml of blood be outside the body at one time.

After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma, which contains the [[antibodies]], is first treated and then returned to the patient in traditional plasmapheresis. Rarely, other replacement fluids, such as [[hydroxyethyl starch]], may be used in individuals who object to blood transfusion but these are rarely used due to severe side-effects. Medication to keep the blood from clotting (an [[anticoagulant]]) is given to the patient during the procedure.<ref name="Ruizetal" />

Plasmapheresis is used as a therapy in particular [[disease]]s. It is an uncommon treatment in the United States, but it is more common in Europe and particularly Japan.<ref>{{cite journal|title=Plasmapheresis in the dysproteinemias|pmid=11886576|year=2002|last1=Drew|first1=MJ|volume=6|issue=1|pages=45–52|journal=Therapeutic Apheresis|doi=10.1046/j.1526-0968.2002.00393.x}}</ref>

An important use of plasmapheresis is in the therapy of [[autoimmune disorder]]s, where the rapid removal of disease-causing [[autoantibodies]] from the circulation is required in addition to other medical therapy. It is important to note that plasma exchange therapy in and of itself is useful to temper the disease process, while simultaneous medical and [[immunosuppressive therapy]] is required for long-term management. Plasma exchange offers the quickest short-term answer to removing harmful autoantibodies; however, the production of autoantibodies by the immune system must also be suppressed, usually by the use of medications such as [[cyclophosphamide]], [[cyclosporine]], [[Cellcept|mycophenolate mofetil]], [[prednisone]], [[rituximab]], or a mixture of these.<ref name="Savageetal1986">{{cite journal |last1=Savage |first1=C O |last2=Pusey |first2=C D |last3=Bowman |first3=C |last4=Rees |first4=A J |last5=Lockwood |first5=C M |title=Antiglomerular basement membrane antibody mediated disease in the British Isles 1980-4. |journal=BMJ |date=1 February 1986 |volume=292 |issue=6516 |pages=301–304 |doi=10.1136/bmj.292.6516.301 |url=https://www.bmj.com/content/292/6516/301 |access-date=5 January 2025|pmc=1339276 }}</ref>

Other uses are the removal of blood [[proteins]] where these are overly abundant and cause [[hyperviscosity syndrome]].<ref name="Nakanishietal2014">{{cite journal |last1=Nakanishi |first1=Takeshi |last2=Suzuki |first2=Naoki |last3=Kuragano |first3=Takahiro |last4=Nagasawa |first4=Yasuyuki |last5=Hasuike |first5=Yukiko |title=Current topics in therapeutic plasmapheresis |journal=Clinical and Experimental Nephrology |date=February 2014 |volume=18 |issue=1 |pages=41–49 |doi=10.1007/s10157-013-0838-0 |url=https://link.springer.com/article/10.1007/s10157-013-0838-0 |access-date=5 January 2025|url-access=subscription }}</ref>

There is weak evidence that therapeutic plasma exchange (TPE) might be of benefit in severe cases of [[COVID-19]].<ref>{{cite journal |vauthors=Abdelwahab OA, Diab RA, Elsaeidy KS, Albakri K, El-Samahy M, Ramadan O, Negida A, Seif AM, Al-Alfy MN |title=Efficacy of therapeutic plasma exchange in patients with severe COVID-19: A systematic review and meta-analysis |journal=Rev Med Virol |volume= 33|issue= 3|pages=e2435 |date=March 2023 |pmid= 36905184  |doi=10.1002/rmv.2435 |s2cid=257437894 |type=Systematic review}}</ref>

===Examples of diseases that have been treated with plasmapheresis===
{{Further|Apheresis#Diseases and disorders}}
{{div col|colwidth=28em}}
* [[Acute disseminated encephalomyelitis]] (ADEM)
* [[Anti-NMDA receptor encephalitis]]
* [[Antiphospholipid antibody syndrome]] (APS or APLS)
* [[Behcet syndrome]]
* [[Chronic inflammatory demyelinating polyneuropathy]]
* [[Goodpasture's syndrome]]
* [[Granulomatosis with polyangiitis]]
* [[Graves' disease]] in infants and neonates
* [[Guillain–Barré syndrome]]
* [[HELLP syndrome]]
* [[HIV]]-related [[neuropathy]]<ref>Kiprov D.D., Stricker R.B., Miller R.G.
''Int. Conf. AIDS''. 1992 Jul 19-24; 8: 95 (abstract no. PuB 7281). [https://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102202279.html U.S. Nat'l Institutes of Health, NLM Gateway]{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }}. Abstract retrieved 8-22-2009.</ref>
* [[Hyperviscosity syndrome]]s:
** [[Cryoglobulinemia]]
** [[Paraproteinemia]]
** [[Waldenström macroglobulinemia]]
* [[Idiopathic pulmonary fibrosis]]
* [[Lambert-Eaton syndrome]]
* [[Microscopic polyangiitis]]
* [[Guillain–Barré syndrome#Classification|Miller Fisher syndrome]]<ref>{{cite journal|title=Plasmapheresis and Miller Fisher syndrome: analysis of 50 consecutive cases|pmid=11971070|url= |pmc=1737859|doi=10.1136/jnnp.72.5.680|year=2002|last1=Mori|first1=M|last2=Kuwabara|first2=S|last3=Fukutake|first3=T|last4=Hattori|first4=T|volume=72|issue=5|pages=680|journal=Journal of Neurology, Neurosurgery, and Psychiatry}}</ref>
* [[Multiple sclerosis]]
* [[Myasthenia gravis]]
* [[Neuromyelitis optica]]
* [[Opsoclonus myoclonus syndrome]]
* [[PANDAS|PANDAS syndrome]] (experimental, unproven)<ref name= Wilbur2019>{{cite journal |vauthors=Wilbur C, Bitnun A, Kronenberg S, Laxer RM, Levy DM, Logan WJ, Shouldice M, Yeh EA |title=PANDAS/PANS in childhood: Controversies and evidence |journal=Paediatr Child Health |volume=24 |issue=2 |pages=85–91 |date=May 2019 |pmid=30996598 |pmc=6462125 |doi=10.1093/pch/pxy145}}</ref><ref name=Sigra2018>{{cite journal |vauthors=Sigra S, Hesselmark E, Bejerot S |title=Treatment of PANDAS and PANS: a systematic review |journal=Neurosci Biobehav Rev |volume=86 |issue= |pages=51–65 |date=March 2018 |pmid=29309797 |doi=10.1016/j.neubiorev.2018.01.001 |s2cid=40827012 |doi-access=free }}</ref>
* [[Pemphigus vulgaris]]
* [[Focal segmental glomerulosclerosis|Recurrent focal and segmental glomerulosclerosis in the transplanted kidney]]
* [[Refsum disease]]
* [[Rhabdomyolysis]]
* [[Systemic sclerosis]] (scleroderma)<ref>{{cite journal|title=Therapeutic plasma exchange for the treatment of systemic sclerosis: A comprehensive review and analysis|doi=10.1177/2397198318758606|year=2018|last1=Harris|last2=Meiselman|last3=Moriarty|last4=Metzger|last5=Malkovsky|first1=Edward|first2=Herbert|first3=Patrick|first4=Allan|first5=Miroslav|journal=Journal of Scleroderma and Related Disorders|volume=3|issue=2|pages=132–152|pmid=35382237 |pmc=8892860 |doi-access=free}}</ref>
* [[Thrombotic thrombocytopenic purpura]] (TTP) / [[hemolytic uremic syndrome]]
* [[Toxic epidermal necrolysis]] (TEN)
* [[Transverse myelitis]]
{{div col end}}

===Complications of plasmapheresis therapy===
Though plasmapheresis is helpful in certain medical conditions, like any other therapy, there are potential risks and complications. Insertion of a rather large [[intravenous]] catheter can lead to bleeding, lung puncture (depending on the site of catheter insertion), and, if the catheter is left in too long, it can get infected.<ref name="madore2002">{{cite journal |last1=Madore |first1=François |title=Plasmapheresis |journal=Critical Care Clinics |date=April 2002 |volume=18 |issue=2 |pages=375–392 |doi=10.1016/S0749-0704(01)00010-0 |url=https://www.criticalcare.theclinics.com/article/S0749-0704(01)00010-0/fulltext |access-date=5 January 2025|url-access=subscription }}</ref>

Aside from placing the catheter, the procedure itself has complications. When patient blood is outside of the body passing through the plasmapheresis machine, the blood has a tendency to clot. To reduce this tendency, in one common protocol,{{which|date=July 2012}} [[sodium citrate]] is infused while the blood is running through the circuit. Citrate binds to [[calcium]] in the blood, calcium being essential for blood to clot. Citrate is very effective in preventing blood from clotting; however, its use can lead to life-threateningly low calcium levels. This can be detected using the [[Chvostek's sign]] or [[Trousseau sign of latent tetany|Trousseau's sign]]. To prevent this complication, calcium is infused intravenously while the patient is undergoing the plasmapheresis; in addition, calcium supplementation by mouth may also be given.<ref name="pinketal2017">{{cite journal |last1=Pink |first1=J. |last2=Bell |first2=B. |last3=Kotsiou |first3=G. |last4=Wright |first4=S. |last5=Thyer |first5=J. |title=Safe and sustainable plasmapheresis |journal=ISBT Science Series |date=November 2017 |volume=12 |issue=4 |pages=471–482 |doi=10.1111/voxs.12387 |url=https://onlinelibrary.wiley.com/doi/full/10.1111/voxs.12387 |access-date=5 January 2025|url-access=subscription }}</ref>

Other complications include:
* Bleeding or [[hematoma]] from needle placement
* [[Hypotension]]
* Potential exposure to blood products, with risk of [[transfusion reaction]]s or transfusion transmitted diseases
* Suppression of the patient's [[immune system]]