Key Points
ÎÎPlasmapheresis, also known as therapeutic plasma exchange, is a
procedure that involves separating the blood, exchanging the plasma
(typically with donor plasma or albumin solution), and returning the
other components, primarily red blood cells, to the patient.
ÎÎThe mechanics of plasmapheresis have not changed since the
introduction of continuous flow machines.
Selecting a Treatment Regimen
Acute Inflammatory Demyelinating Polyneuropathy
(AIDP)/Guillain-Barré Syndrome (GBS)
ÎÎPlasmapheresis should be offered in the treatment of AIDP/GBS
severe enough to impair independent walking or to require mechanical
ventilation (Level A).
ÎÎPlasmapheresis should be considered in the treatment of milder
clinical presentations of AIDP/GBS (Level B).
Remark: IV immunoglobulin (IVIg) is an alternative treatment used in patients
with AIDP/GBS. There is insufficient evidence to demonstrate the superiority of one
treatment over the other.
Chronic Inflammatory Demyelinating Neuropathy (CIDP)
ÎÎPlasmapheresis should be offered as a short-term treatment for
patients with CIDP (Level A).
Remark: Steroids, IVIg, and immunosuppressants have also been used in the
treatment of CIDP.
CNS Demyelinating Disease
ÎÎBased on a single, small Class II study, plasmapheresis is possibly
effective for acute fulminant CNS demyelinating diseases (multiple
sclerosis [MS], transverse myelitis [TM], acute disseminated
encephalomyelitis [ADEM], Marburg variant, neuromyelitis optica
[NMO], recurrent myelitis, focal cerebral demyelination) that fail to
respond to high-dose corticosteroid treatment.
Note: Because the study included subgroups of patients with demyelinating diseases, it
is not possible to determine if plasmapheresis is more or less effective in patients with
different demyelinating diseases.
ÎÎPlasmapheresis may be considered in the treatment of fulminant CNS
demyelinating diseases that fail to respond to high-dose corticosteroid
treatment (Level C).
