An important use of plasmapheresis is in the therapy of autoimmune disorders, where the rapid removal of disease-causing autoantibodies from the circulation is required in addition to other medical therapy. It is important to note that plasma exchange therapy in and of itself is useful to temper the disease process, while simultaneous medical and immunosuppressive therapy is required for long-term management.
Plasma exchange offers the quickest short-term answer to removing harmful autoantibodies; however, the production of autoantibodies by the immune system must also be suppressed, usually by the use of medications such as prednisone, cyclophosphamide, cyclosporine, mycophenolate mofetil, rituximab, or a mixture of these.
Plasma exchange is typically performed by extracting blood through a vein in one arm, circulating the blood through a machine, extracting the old plasma, mixing in the new plasma and re-introducing the blood through a vein in another arm. This may have high stress on the veins in the arms and may not be effective in the long term. In some cases, the plasma exchange is performed by using a line in the jugular vein.
Replacing 100 per cent volume of plasma is about 70 per cent effective as the old and new plasma are continually mixed together. The range may be increased to 150 or 200 per cent volume to increase the overall reduction in old plasma.
To impact Thrombotic Thrombocytopenic Purpura (TTP), plasma exchange is performed on a daily basis while the platelet count is measured to check results. The goal is to get the platelet count into the normal range between 150 and 450. Once 150 is met, plasma exchange may be tapered off and performed every second or third day.
Personally, I have had plasma exchange through both the arms and the jugular vein. I have had plasma exchange performed 39, 10 and 21 (more to come) times to treat my three episodes with TTP.
Thanks,
@BruceFightsTTP
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