Plasmapheresis (from the Greek ''πλάσμα - plasma'', something molded, and ''ἀφαίρεσις - aphairesis'', taking away) is the removal, treatment, and return of (components of) blood plasma from blood circulation. It is thus an extracorporeal therapy. The method can also be used to collect plasma for further manufacturing into a variety of medications.
The procedure is used to treat a variety of disorders, including those of the immune system, such as Guillain-Barre syndrome, lupus, and TTP. Dr. D. J. Wallace states that Michael Rubinstein was the first person to use plasmapheresis to treat an immune-related disorder when he "saved the life of an adolescent boy with thrombotic thrombocytopenic purpura (TTP) at the old Cedars of Lebanon Hospital
in Los Angeles in 1959". Also according to Wallace, the modern plasmapheresis process itself originated in the "National Cancer Institute between 1963 and 1968, [where investigators drew upon an old dairy creamer separation technology first used in 1878 and refined by Edward Cohn's centrifuge marketed in 1953.
Complications of plasmapheresis therapy
Though plasmapheresis is helpful in certain medical conditions, like any other therapy, there are potential risks and complications. Insertion of a rather large intravenous catheter can lead to bleeding, lung puncture (depending on the site of catheter insertion), and, if the catheter is left in too long, it can get infected.
Aside from placing the catheter, the procedure itself has complications. When patient blood is outside of the body passing through the plasmapheresis machine, the blood has a tendency to clot. To reduce this tendency, in one common protocol, citrate is infused while the blood is running through the circuit. Citrate binds to calcium in the blood, calcium being essential for blood to clot. Citrate is very effective in preventing blood from clotting; however, its use can lead to life-threatening low calcium levels. This can be detected using the Chvostek's sign or Trousseau's sign. To prevent this complication, calcium is infused intravenously while the patient is undergoing the plasmapheresis; in addition, calcium supplementation by mouth may also be given.
Other complications include:
- Potential exposure to blood products, with risk of transfusion reactions or transfusion transmitted diseases
- Suppression of the patient's immune system
- Bleeding or hematoma from needle placement
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