Plasmapheresis

Overview

Involves extracorporeal separation of blood products, resulting in filtered plasma product
Patient's plasma is removed, blood cells re-infused, and (usually) donor plasma transfused
In US and other high-resourced settings, separation typically done by automated centrifuge

Established indications for plasmapheresis as first-line treatment (either alone or in conjunction with other agents)
- Guillain-Barre syndrome
- Thrombotic thrombocytopenic purpura
- Myasthenia gravis
- Hyperviscosity syndrome
- Diffuse alveolar hemorrhage due to Goodpasture syndrome
- Chronic inflammatory demyelinating polyneuropathy
- Severe autoimmune hemolytic anemia
Indications for which plasmapheresis is accepted second-line therapy:
- Lambert-Eaton myasthenic syndrome
- Multiple sclerosis: acute CNS demyelination unresponsive to steroids
- Rapidly progressive vasculitis
- Catastrophic thrombosis due to antiphospholipid syndrome
- Acute disseminated encephalomyelitis
- Severe systemic lupus erythematosus
- Multiple myeloma cast nephropathy
- RBC alloimmunization in pregnancy
- Mushroom Poisoning
- Hemolytic uremic syndrome
Less established, possible indications
- Thyroid storm when antithyroid drugs ineffective or contraindicated
- Pemphigus vulgaris (severe and refractory to first-line management)
- Pyoderma gangrenosum

Hemodynamic instability, sepsis, or other conditions causing inability to tolerate fluid shifts
Inability to tolerate central line placement
Allergy to FFP or albumin
Severe hypocalcemia (citrate anticoagulant will precipitate calcium and worsen hypocalcemia)

See central line
Additional steps specific to device being used to apherese, consult specialist for this!