Therapeutic Plasma Exchange

What is therapeutic plasma exchange?

Therapeutic plasma exchange (plasmapheresis) is a procedure to remove plasma from the blood and replace it with healthy plasma or another fluid. Plasma is the fluid part of blood that carries blood cells. Plasma exchange can be used to treat certain medical conditions, such as some blood disorders, cancers, or neurologic conditions.

Plasma exchange is a type of apheresis, a procedure to remove a part of the blood. An apheresis machine removes blood from a vein and separates the blood into parts. Your child’s plasma is collected and discarded. The rest of the blood is mixed with healthy plasma or a replacement fluid. The blood is returned to the body through a vein. Only a small part of your child’s blood is out of the body at any time.

What to expect during plasma exchange

Plasma exchange usually takes 2–3 hours total. Your care team will explain what to expect and answer any questions.

Your child will be in bed during the procedure. Have your child wear comfortable, loose-fitting clothing. During the procedure, your child can watch a movie, read, color, or have games or toys that can be played with in the bed.

Your care team decides the best way to access your child’s veins. This is based on the size of the veins and the number of times they may need red blood cell exchange treatments. The procedure can be done with one line (single needle procedure) or 2 lines (double needle procedure).

Types of access include:

• Central venous catheter (central line) placed into a large vein in the neck, chest, or groin
• Intravenous (IV) line placed in the arm

Your care team will take steps to reduce the risk of infection. All tubes that touch the blood are sterile (free from germs) and are only used once.

Your apheresis nurse will stay at the bedside to monitor for any reactions or problems.

Because your child will have tubes attached to the apheresis machine, they will not be able to leave the room once the procedure has started. Portable toilet equipment will be provided if needed.

Possible side effects of plasma exchange

The side effects of plasma exchange are like those that can happen when people donate whole blood. Any side effects are usually mild and temporary. There is always the risk of rare or unknown side effects.

Side effects may include:

• Nausea
• Dizziness
• Fainting
• Pain or bruising at the site where the needle is placed
• Blood loss
• Infection
• A lower blood cell count after the procedure. This decrease is usually small. But a blood transfusion or other therapy may be necessary.
• A reaction to the blood products received during this exchange. Although not common, this may require that the procedure is stopped.
• If plasma exchange is stopped before it is complete, a small amount of blood may not be returned to the body.

Side effects caused by blood-thinning medicine

During plasma exchange, your provider may give your child a medicine called citrate. This is a blood-thinning medicine. It keeps the blood from clotting in the apheresis machine.

Citrate may cause side effects that include:

• Muscle cramping
• Numbness
• Chills
• Tingling sensations
• Strange or metallic taste in the mouth
• Feeling anxious
• Seizures (in rare cases)
  

The care team may give your child calcium, either by mouth or by vein, to prevent or treat these reactions.

When to contact your care team

Tell a member of your care team right away if your child has any of these symptoms during or after apheresis:

• Unusual sensations
• Discomfort
• Other side effects

If you have questions about your child’s procedure, talk to your care team.