Plasma exchange - also known as plasmapheresis
The goal of plasma exchange
Plasma exchange is a treatment, which is used to remove harmful substances from a persons blood, which can cause certain illnesses. Typically, this procedure begins during the acute phase of the illness, alongside a second treatment, called the medical treatment. Plasma exchange can benefit a patient quickly, but usually the body will not show a significant response to the medical treatment for the first few days. After this, further plasma exchanges may be unnecessary. Commonly, five plasma exchange treatments are necessary, and these take place within a period of 1-2 weeks.
The procedure
Blood mainly consists of three major components: red blood cells, white blood cells, and plasma. During plasma exchange, a small amount of blood runs up a vessel and into a machine, which separates it into several different fluids. After separation, much of the plasma drains into a storage bag, but the red and white blood cells flow back through a second vessel, and they return to the blood. The plasma, which was removed from your blood, is replaced by albumin or plasma from a donor. The albumin originally comes from donated plasma. Generally the treatment does not cause patients any bother (but see below for potential adverse effects), and you can rest up, sleep or watch TV, while we treat you. Our personnel will be by your side throughout the entire procedure.
Preparation, information and consent
Before the treatment can begin, a doctor from your base ward will discuss the procedure with you. If you give consent to go forward with the treatment, a preliminary plan will be made, which will include how many treatments you may need, and how often they should occur. Before the initiation of the first treatment, you will be informed by a doctor from the Clinical Immunology Department (also known as KIA), which is the department which carries out the treatment.
Prior to the treatment
Before the treatment can begin, a cannula must be inserted into one or two of your veins. This can be either one vein in each arm, or a single large vein in your neck.
As a rule, you should have had blood tests taken on the day before each treatment. If you do not have a recent ECG (a diagram which reveals the electrical activity within the heart), it could also be necessary to carry out this quick and simple test before the treatment.
Your personal preparation
We recommend as a rule of thumb, that you eat and drink plenty prior to the treatment. Ask the doctors on your base ward, what you should do, if you are in doubt about anything. With certain kidney diseases, heart diseases, and other conditions, where it can be necessary that you limit your intake of fluids, other rules may apply. The treatment takes typically 2-4 hours, and you must be prepared to stay in your bed throghout this period.
If the treatment runs through cannulae in your arms, it will be necessary to lie with your arms straight
throughout the procedure.
Adverse effects from plasma exchange
During the treatment, unpleasant sensations may arise, including tingling around the mouth and in the fingertips, nausea, or general discomfort. Normally, a glass of water, which contains a fizzy chalk (calcium) tablet, can easily reduce these symptoms. A calcium drip through a cannula (intravenous infusion) is another effective treatment for this.
In addition to the effects already mentioned, there is a lower risk, that there may be other adverse effects from the treatment. These effects will be short-lived in the vast majority of cases. They typically include:
- Nausea and vomiting
- Heart palpitations
- Intense sweating
- An allergic reaction (most often in the form of a rash, i.e. hives or urticaria)
In some very rare cases, serious adverse effects could arise, including muscle spasms, a drop in blood pressure, or breathing difficulties.
In order to minimize the risk of adverse effects, and to help you feel safe, we keep a close eye on you during the treatments. It is important that you tell us, if you experience discomfort.
Adverse effects from the insertion of a cannula prior to the procedure
There is a risk of adverse effects resulting from the insertion of a cannula into a vein prior to the treatment. Generally, these adverse effects are uncommon, but the risks vary with the method, which was used for the insertion of the cannula. The doctors on your ward can tell you about the choice of cannulation technique and about what the risk of various adverse effects would be.
Further information
If you have questions or you would like anything clarified further, at any time, you can ask a doctor on your ward. Otherwise, you can ask the doctor who comes to speak to you, just before the initiation of your first plasma exchange treatment.