Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point of care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

For more information, click below.


Subscribers log in here


Prescription and technique of therapeutic plasma exchange

INTRODUCTION

Therapeutic plasma exchange (TPE, plasmapheresis) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from the plasma. This topic will review the basic elements of the plasma exchange prescription and technique [1]. Indications for and complications of TPE are discussed elsewhere. (See "Indications for therapeutic plasma exchange" and "Complications of therapeutic plasma exchange".)

PRESCRIPTION

In general, large molecular weight compounds equilibrate slowly between the vascular space and the interstitium. Thus, calculations of the rate of removal by TPE can be simplified to first order kinetics. A single plasma volume exchange will lower plasma macromolecule levels by 60 percent and an exchange equal to 1.4 times the plasma volume will lower plasma levels by 75 percent [2,3].

The following formula can be used to estimate the plasma volume in an adult [4]:

 Estimated plasma volume (in liters)  =  0.07  x  weight (kg)  x  (1  -  hematocrit)

Performing more than one plasma volume exchange increases procedure time, challenges patient tolerance, and increases the cost. As an example, currently available cell separators can perform one complete volume exchange in 1.5 to 2 hours; exchanges equaling two to three plasma exchanges will double or triple the time required to perform the procedure. For most conditions in which plasmapheresis is used, it is considered acceptable to perform 1 to 1.5 plasma volume exchanges per procedure.

           

Subscribers log in here

To continue reading this article you must have access through your hospital or your group practice, log in to your personal subscription, or purchase a personal subscription. For more information, click below.
Literature review current through: May 2013. | This topic last updated: Jun 13, 2012.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2013 UpToDate, Inc.
References
Top
  1. Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis 2008; 52:1180.
  2. Kaplan AA, Halley SE. Plasma exchange with a rotating filter. Kidney Int 1990; 38:160.
  3. Kaplan AA. Towards a rational prescription of plasma exchange: The kinetics of immunoglobulin removal. Semin Dial 1992; 5:227.
  4. Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans 1990; 36:M597.
  5. Leitman SF, Ciaverella D, McLeod B, et al. Guidelines for Therapeutic Hemapheresis, American Association of Blood Banks, Bethesda 1994.
  6. Therapeutic Apheresis, Kolins J, Jones JM (Eds), American Association of Blood Banks, Arlington 1983. p.2.
  7. Keller AJ, Urbaniak SJ. Intensive plasma exchange on the cell separator: effects on serum immunoglobulins and complement components. Br J Haematol 1978; 38:531.
  8. Tabor E. The epidemiology of virus transmission by plasma derivatives: clinical studies verifying the lack of transmission of hepatitis B and C viruses and HIV type 1. Transfusion 1999; 39:1160.
  9. Technical Manual, 11th ed, Walker RH (Ed), American Association of Blood Banks, Bethesda 1993. p.37.
  10. Obrador GT, Zeigler ZR, Shadduck RK, et al. Effectiveness of cryosupernatant therapy in refractory and chronic relapsing thrombotic thrombocytopenic purpura. Am J Hematol 1993; 42:217.
  11. Rock G, Shumak KH, Sutton DM, et al. Cryosupernatant as replacement fluid for plasma exchange in thrombotic thrombocytopenic purpura. Members of the Canadian Apheresis Group. Br J Haematol 1996; 94:383.
  12. Szczepiorkowski ZM, Winters JL, Bandarenko N, et al. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25:83.
  13. Laskin BL, Goebel J, Davies SM, Jodele S. Small vessels, big trouble in the kidneys and beyond: hematopoietic stem cell transplantation-associated thrombotic microangiopathy. Blood 2011; 118:1452.