Plasmapheresis with hemodialysis equipment
- Andre A Kaplan, MD
Andre A Kaplan, MD
- Professor of Medicine
- University of Connecticut Health Center
Traditionally, therapeutic plasma exchange (TPE, plasmapheresis) was performed with centrifugation devices used in blood blanking procedures. (See "Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology".)
These devices permit selective cell removal (cytapheresis) but have been associated with posttreatment thrombocytopenia  and require a dedicated centrifuge device. An increasingly popular and often more efficient alternative is to perform plasma exchange by membrane plasma separation (MPS) [2-5].
MPS utilizes a highly permeable membrane and a standard dialysis machine used in its ultrafiltration mode, dialysis-bypass mode (similar to the technique in hemoperfusion). TPE is also possible using NxStage and Prismaflex continuous renal replacement therapy (CRRT) machines. The NxStage machine employs a cartridge that uses the Plasmaflo OP-05H as the filtration membrane. (See 'Technical considerations' below and "Short daily home hemodialysis: The low dialysate volume approach" and "Continuous venovenous hemodialysis: Technical considerations".)
For many years, the most commonly used membrane in the United States was the Plasmaflo AP-05H. This filter has been replaced with a slightly more porous filter, the OP-05W . This filter can be used with most dialysis machines, but the Cobe 3 and Hospal machines are incompatible with the filter's tubing.
The published American experience with MPS is very limited even though thousands of treatments are performed in the United States each year [7-9]. In some countries, such as Germany and Japan, 90 percent of plasmapheresis treatments are performed by membrane plasma separation [5,10].
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