Therapeutic plasma exchange: Indications
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
- Andre A Kaplan, MD
Andre A Kaplan, MD
- Professor of Medicine
- University of Connecticut Health Center
Therapeutic plasma exchange (TPE, plasmapheresis) is an automated extracorporeal apheresis technique designed to remove or reduce the concentration of large molecular weight substances from the plasma. Examples of these substances include pathogenic autoantibodies, immune complexes, cryoglobulins, myeloma light chains, endotoxin, and cholesterol-containing lipoproteins (table 1).
Indications for TPE will be discussed here. The prescription, technique, and complications of TPE are discussed separately. (See "Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology" and "Therapeutic apheresis (plasma exchange or cytapheresis): Complications".)
The use of TPE in specific disorders is discussed in separate topic reviews. (See 'General therapeutic categories' below and "Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology".)
The following terminology is used to describe procedures related to plasma exchange:
●Apheresis – An umbrella term for "taking away" a blood component. Apheresis includes plasmapheresis (taking away plasma) and hemapheresis (taking away blood cells). Of note, we do not use the term "pheresis," which is a shortened pronunciation (slang) for apheresis.
- COHEN S, FREEMAN T. Metabolic heterogeneity of human gamma-globulin. Biochem J 1960; 76:475.
- Lockwood CM, Worlledge S, Nicholas A, et al. Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange. N Engl J Med 1979; 300:524.
- Schroeder JO, Euler HH, Löffler H. Synchronization of plasmapheresis and pulse cyclophosphamide in severe systemic lupus erythematosus. Ann Intern Med 1987; 107:344.
- Leitman SF. American Association of Blood Banks/American Society for Apheresis survey, 1992 (unpublished data).
- Rock G, Canadian Apheresis Study Group survey, 1991, personal communication.
- Clark WF, Rock GA, Buskard N, et al. Therapeutic plasma exchange: an update from the Canadian Apheresis Group. Ann Intern Med 1999; 131:453.
- Rock G, Clark B, Sutton D, et al. The Canadian apheresis registry. Transfus Apher Sci 2003; 29:167.
- 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.
- Szczepiorkowski ZM, Shaz BH, Bandarenko N, Winters JL. The new approach to assignment of ASFA categories--introduction to the fourth special issue: clinical applications of therapeutic apheresis. J Clin Apher 2007; 22:96.
- Smith JW, Weinstein R, Hillyer KL, et al. Therapeutic apheresis: a summary of current indication categories endorsed by the AABB and the American Society for Apheresis. Transfusion 2003; 43:820.
- Szczepiorkowski ZM, Bandarenko N, Kim HC, 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 2007; 22:106.
- Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013; 28:145.
- Shaz BH, Linenberger ML, Bandarenko N, et al. Category IV indications for therapeutic apheresis: ASFA fourth special issue. J Clin Apher 2007; 22:176.
- Drew MJ. Plasmapheresis in the dysproteinemias. Ther Apher 2002; 6:45.
- von Baeyer H. Plasmapheresis in immune hematology: review of clinical outcome data with respect to evidence-based medicine and clinical experience. Ther Apher Dial 2003; 7:127.
- Shaz BH, Winters JL, Bandarenko N, Szczepiorkowski ZM. How we approach an apheresis request for a Category III, Category IV, or noncategorized indication. Transfusion 2007; 47:1963.
- Davenport RD. Therapeutic apheresis. In: (AABB) Technical Manual, 17th ed, Roback JD (Ed), AABB Press, Bethesda 2011.
- Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis 2008; 52:1180.