A Guide To The Therapeutic Plasma Exchange Process
What is Therapeutic Apheresis?
Therapeutic Apheresis is a medical procedure that involves directing the blood of the patient’s veins through tubing to a machine that separates the blood into its individual components; the diseased component is removed and/or replaced by specific fluids and the remainder of the blood components are reinfused back into the patient.
What is therapeutic plasma exchange (TPE)?
Plasma is the yellow-colored fluid component of the blood. Therapeutic plasma exchange (TPE) is a procedure in which the patient’s blood is passed through an apheresis machine where the diseased/harmful plasma is removed and discarded with reinfusion of red blood cells along with replacement fluid such as plasma or albumin into the patient.
What conditions is plasma exchange therapy used for?
There are more than 80 conditions that can be managed by Apheresis, TPE is commonly used to treat certain blood, neurologic, or autoimmune diseases such as:
Thrombotic thrombocytopenic purpura – a rare disorder that causes blood clots (thrombi) to form in small blood vessels throughout the body.
Guillain-Barre syndrome – an illness that causes weakness and paralysis of the limbs.
Myasthenia gravis – an autoimmune illness that causes severe muscular weakness.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) – a condition characterized by progressive limb weakness.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive glomerulonephritis – a disease characterized by the inflammation of your kidney’s tiny filters.
Hypergammaglobulinemia – a condition characterized by elevated levels of immunoglobulins in the blood.
Certain types of multiple sclerosis.
Some diseases of the kidney such as Goodpasture’s syndrome and IgA nephropathy.
Disclaimer: mentioned above are some of the conditions treated by TPE. There are numerous other indications for TPE therapy.
What type of vascular access will be used during the procedure?
During a TPE procedure, blood is removed through one of the below vascular access types:
If peripheral intravenous cannulas (IVs) are used, your arms will be raised up on pillows, and you will be asked to squeeze your fist to promote blood flow.
Does this procedure hurt?
The procedure itself is not painful and most people report little or no discomfort during treatment. However, as with any needle puncture, there may be slight discomfort when the central line or IV cannula is inserted.
Sometimes you might feel different sensations that are not painful, which include a slight pulsing from the instrument’s pump, a slight chill, or a cold sensation while blood returns to your body.
What are the pre-procedure assessment criteria?
The pre-procedure assessment criteria are:
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Note: Access (Peripheral IV cannula vs. central line): Prior to the procedure, the vein will be assessed by an Apheresis nurse (if you have poor veins, your physician will order a central line catheter).
How long does this procedure take?
Patients may need to come for the pre-procedure appointment two to three days before the actual procedure day for a sample drawn, assessment and preparations; this may take one hour.
On the day of the procedure, the length of the procedure varies from one patient to another based on laboratory results, total blood volume, height, weight, access condition and type of replacement fluid. The procedure itself may take up to three hours but the preparation for it on the day of the procedure (blood withdrawal, central line placement, etc.) may take another two to three hours.
How will this procedure work for me?
It depends on the disease condition and category, TPE may be used as the first line of treatment in certain conditions. However, it may be used as a supportive treatment in combination with medical treatments for other conditions.
TPE helps reduce symptoms, prevent disease progression and improve prognosis by removing the plasma that contains harmful substances and replacing it with appropriate replacement fluid (albumin/plasma from a healthy donor).
The physician will explain to you more about your disease, condition and treatment plan.
What are the common side effects of the exchange procedure?
The exchange procedure is well tolerated by most people and the side effects are not common.
Some people may experience fainting or light-headedness; you will be monitored throughout the procedure and if this happens, please inform the nurses immediately as you may need a drip of extra fluid to feel better.
During the procedure, you may occasionally get a “pins and needles” (tingling and numbness) feeling in your fingertips or lips, or feel cold or slightly sick due to low calcium levels. If this happens, please inform the apheresis nurse immediately.
If you need to receive blood products during the procedure, side effects related to the transfusion of blood products include fever, chills, flushes, or rashes. Less commonly, chest tightness. You will be monitored for any transfusion reaction and managed accordingly.
Before the procedure, your apheresis care team and physician will go through all the risks and benefits of the procedure with you, and you will have the opportunity to ask questions before signing the consent form.
How often do I need this treatment?
The frequency of TPE procedures depends on your disease, condition and the treating physician in coordination with the apheresis team’s assessment.
How should I prepare for the procedure?
Get a good night’s sleep the night before
Stay hydrated
Before the procedure, eat calcium-rich meals like (milk, yogurt and egg) and avoid heavy fatty meals
Dress for warmth and comfort
Bring a book, novel, or anything for your entertainment
Discuss with the apheresis provider before taking any medicines prior to the procedure
We recommend that a family member or friend accompany you on the day of the procedure as you may feel tired for the rest of the day
What should I do after the procedure?
Please follow the below post-procedure instructions:
Stay in bed for at least 30 minutes for getting monitored prior to discharge.
Have a light meal before you leave and try to have healthy meals and lots of fluids at home.
If you feel any unpleasant reaction at home such as a rash, allergies, fainting, or breathing difficulties, go to the nearest hospital or the SSMC Emergency Department.
Avoid strenuous physical activities for 24 hours post-procedure.
Comply with follow-up appointments with your treating physician and the Apheresis Clinic.
References:
5 Myths of plasma exchange an immunomodulatory therapy – TERUMOBCT
A patient’s guide to plasma exchange – TERUMOBCT
Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue
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