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.
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.
Plasmapheresis may help treat several central nervous system (CNS) demyelinating diseases, including:
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.
Plasmapheresis is a relatively safe procedure, but there are some side effects. These include:
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.”
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