Plasmapheresis

Last updated Nov. 20, 2023, by Susie Strachan
Fact-checked by Patricia Silva, PhD

Plasmapheresis — also known as therapeutic plasma exchange (TPE) — is a type of treatment that can be used in autoimmune diseases such as myasthenia gravis (MG).

During a plasmapheresis treatment, the plasma — the liquid component of blood — is replaced with substitute plasma that does not contain the self-reactive antibodies that cause MG. The purpose of plasmapheresis is to remove these harmful antibodies from circulation in order to prevent the immune system from attacking the body’s own tissues.

Plasmapheresis is typically performed in a hospital or clinical setting. The number and frequency of plasmapheresis treatments, and its long-term effectiveness, may vary depending on a person’s condition and response to the procedure.

How plasmapheresis helps MG patients

MG is a rare chronic disease caused by a person’s antibodies attacking healthy tissue in the body. Plasmapheresis can help relieve MG symptoms, such as muscle weakness, balance problems, and difficulty breathing, by filtering the antibodies that are causing the autoimmune response from the plasma.

The benefits of each TPE treatment are usually rapid but they are not sustained in the long-term. While plasmapheresis can help alleviate symptoms by removing the autoantibodies, it does not stop the autoimmune processes that lead to the production of these antibodies. Over time, new harmful autoantibodies gradually show up in the bloodstream.

Plasmapheresis is commonly used for people with acute symptoms, such as during a myasthenic crisis. This is when the muscles involved in breathing become too weak to move air in and out of the lungs. A person in myasthenic crisis usually requires hospitalization and ventilation support.

According to the American Society for Apheresis guidelines, plasmapheresis is recommended for people with moderately severe MG symptoms and when preparing for surgery to remove the thymus gland (thymectomy).

MG Foundation of America guidelines broaden that recommendation to include plasmapheresis as a maintenance treatment for juvenile MG patients, as well as for people who cannot tolerate immunosuppressants.

How plasmapheresis is performed

Plasmapheresis is a relatively painless procedure that takes one to three hours to complete.

During plasmapheresis treatment, intravenous lines draw blood from one arm, which passes through a device to remove the person’s plasma and filter out the antibodies. Substitute plasma (replacement fluids) is then added to the person’s blood cells and returned into the body through the other arm.

Doctors schedule plasmapheresis treatment based on each person’s needs. For instance, some people with MG may require plasma exchange every day while others get the treatment once a month, until symptoms diminish.

Symptoms may start to ease after a few first procedures. The benefits of plasmapheresis treatment may last up to two months, although its effectiveness is variable.

When treating a myasthenic crisis, a person may need five or six plasma exchanges or more. And it may take a few days to take effect.

Preparing for plasmapheresis

Some tips for preparing for plasmapheresis include:

• Eat a balanced meal before the treatment.
• Be well rested.
• On the day of treatment, wear comfortable clothing that won’t interfere with the placement of intravenous lines.
• Bring a family member or friend with you for emotional support.

Side effects of plasmapheresis

There are not usually any substantial plasmapheresis side effects or risks. It is a relatively painless procedure, but it can be uncomfortable since it involves having a needle inserted into a vein on each arm or hand.

The most common plasmapheresis side effects are:

• low blood pressure, which can cause symptoms such as drowsiness, nausea, and blurred vision
• bruising or swelling around the needle puncture site.

An anti-clotting agent, or blood thinner, is given during the procedure. This may cause tingling or numbness in the fingers, bleeding, or allergic reactions. People with MG should update healthcare staff on how they are feeling during the procedure.

PTE filters out all of the antibodies in the plasma. It does not distinguish between disease-causing and the regular infection-fighting antibodies. This may lead to an extreme suppression of the immune system. The doctor may choose to administer infection-fighting antibodies after each procedure in order to increase the levels of these important antibodies.

Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.