Key Points
ÎPlasmapheresis, 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.
ÎThe 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)
ÎPlasmapheresis should be offered in the treatment of AIDP/GBS severe enough to impair independent walking or to require mechanical ventilation (Level A).
ÎPlasmapheresis 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)
ÎPlasmapheresis 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
ÎBased 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.
ÎPlasmapheresis may be considered in the treatment of fulminant CNS demyelinating diseases that fail to respond to high-dose corticosteroid treatment (Level C).
