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Plasmapheresis: Plasma Exchange and MS

Posted on March 18, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Emily Wagner, M.S.

Plasmapheresis, also known as therapeutic plasma exchange, is a process in which blood is removed, filtered outside the body, and then replaced. This treatment is commonly used to treat autoimmune diseases such as multiple sclerosis (MS). In MS, the immune system makes antibodies against its own healthy tissues (known as autoantibodies) that target the body’s nervous system. Plasmapheresis helps remove the autoantibodies from the blood.

Plasmapheresis can be used to alleviate the symptoms of MS. This therapy does not treat MS at the source but instead can help provide relief.

When Is Plasmapheresis Used for MS?

If a person with MS cannot tolerate high doses of corticosteroids, plasmapheresis is used as a second-line therapy. Plasma exchange is primarily used to manage relapses (also known as attacks or flares). The American Academy of Neurology (AAN) recommends the use of therapeutic plasma exchange to treat people with severe relapses in MS and other neurological diseases. However, it is not an effective treatment for progressive MS.

Conditions Treated by Plasmapheresis

Plasmapheresis may help treat several central nervous system (CNS) demyelinating diseases, including:

  • Multiple sclerosis
  • Myasthenia gravis
  • Neuromyelitis optica
  • Acute inflammatory demyelinating polyneuropathy (Guillain-Barre syndrome)
  • Acute disseminated encephalomyelitis
  • Idiopathic optic neuritis
  • Idiopathic transverse myelitis

How Does Plasmapheresis Work?

Plasmapheresis is a relatively straightforward and safe procedure that is performed in a specialized unit, typically in a hospital. It is possible to receive outpatient treatment, but it is often performed in the hospital when people are receiving other treatments.

You should prepare by drinking six to eight glasses of water (or other noncaffeinated fluids) per day for up to three days before the procedure. Hydrating well can help prevent undesired side effects once you are finished.

On the day of plasmapheresis, you can expect to have an intravenous (IV) needle inserted into one vein in each arm, connected to a tube that feeds into the apheresis machine. In some cases, the health care provider may use a catheter or choose to use a larger vein in the groin or shoulder instead. Then, blood is removed from one IV needle and enters the machine, where it is mixed with anticoagulants to prevent the blood from clotting. The apheresis machine then filters the plasma out of the blood, removing autoantibodies and other substances that may cause inflammation. Donor plasma or a plasma substitute (typically saline or albumin) is then mixed in with the remaining blood cells. Finally, the filtered blood is returned to your body through the other needle.

Overall, the entire process takes two to four hours. You may experience nausea, light-headedness, and numbness or tingling during the procedure. Afterward, you may also feel tired for the rest of the day, which is normal. Be sure to keep hydrated as well, because some fluid is lost during the filtration process.

Side Effects of Plasmapheresis

Plasmapheresis is a relatively safe procedure, but there are some side effects. These include:

  • Shortness of breath
  • Low calcium levels in the blood
  • Low blood pressure
  • Increased risk of developing infections because antibodies are filtered out
  • Metabolic alkalosis (an imbalance in blood chemistry), which can lead to headaches and seizures
  • Low potassium levels in the blood, which can occur when nonplasma substitutes are used
  • Allergic reactions, which can occur when donor plasma is used

Is Plasmapheresis Effective?

A handful of clinical trials have investigated the effects of plasmapheresis in the treatment of MS. One randomized study of people with an acute exacerbation of MS (an attack or flare-up) found that after four weeks of treatment, the plasmapheresis group saw significant improvement in relapsing/remitting MS. Their improvements continued up to 12 months after treatment. Another randomized study of people with demyelinating disease found that plasmapheresis improved their symptoms, and the effect continued even after treatments had stopped.

On MyMSTeam, members have discussed their experiences with plasmapheresis treatment. “I did plasmapheresis about eight years ago when I had a bad relapse. Steroids didn’t work, but the plasmapheresis did! Didn’t bring everything back, but I am walking,” said one member. Another shared, “I actually started to feel relief in my legs [during] the first treatment on the first day that I couldn’t wait to do the other five [treatments]. For me, it helped me so much.”

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 164,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Are you living with MS? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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