View source for 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

==Indications==
*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]]

==Contraindications==
*[[shock|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)

==Equipment Needed==
*Dialysis or pheresis catheter
*[[Central line]] supplies
*Automated centrifuge or semipermeable membrane
*[[FFP]]

==Procedure==
*See [[central line]] 
*Additional steps specific to device being used to apherese, consult specialist for this!

==Complications==
*[[Transfusion reactions]]
**[[Allergic transfusion reaction]]
**[[Transfusion-associated circulatory overload]] (TACO)
**[[Transfusion-related acute lung injury]] (TRALI)
**[[Transfusion-associated graft-versus-host disease]] (rare in plasma exchange)
**[[Fluid overload]]
**[[Sepsis]]
**[[Transfusion infections]]
*Immunosuppression 
*[[Hypocalcemia]]
*Complications of [[central line]] placement

==See Also==
*[[Transfusion reaction]]

==External Links==

==References==
<references/>

[[Category:Procedures]]
[[Category:Heme/Onc]]