plasmapheresis (plasma exchange)

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^[1]^[2]

Indications

Guillain-Barre syndrome
chronic inflammatory demyelinating polyradiculopathy (CIDP)
myasthenia gravis
- severe, prior to initiation of prednisone
- preparation for thymectomy
thrombotic thrombocytopenic purpura (TTP)
cryoglobulinemia
glomerulomephritis
- ANCA-associated glomerulonephritis^[1]
  - granulomatous angiitis, Churg-Strauss syndrome
- anti-glomerular basement membrane disease^[1]
  - Goodpasture's syndrome
- recurrent segmental glomerulosclerosis
hyperviscosity syndrome
- multiple myeloma
  - myeloma cast nephropathy
- Waldenstrom's macroglobulinemia
  - IgM-related polyneuropathy
post-transfusion purpura
fulminant Wilson's disease^[2]
Refsum's disease
paraprotein-associated polyneuropathy^[1]
- Eaton-Lambert myasthenic syndrome
multiple sclerosis
antibody-mediated renal graft rejection^[1]
clopidogrel or ticlopidine-associated thrombotic microangiopathy^[1]

Advantages

fast

Disadvantages

temporary
expensive

Complications

common (up to 30%)

hypocalcemia due to citrate anticoagulant
hypotension (mild)
allergic reactions

Management

stop ACE inhibitor 24 hours before elective apheresis^[1]

More general terms

apheresis

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 2018. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
↑ ^2.0 ^2.1 The Utility of Therapeutic Plasmapheresis for Neurological Disorders NIH Consensus Statement http://consensus.nih.gov/cons/056/056_intro.htm

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