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 and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:

Subscribers log in here

Therapeutic plasma exchange: Prescription and technique


Therapeutic plasma exchange (TPE, plasmapheresis) is an extracorporeal treatment that can be performed by centrifugation or filtration and is designed for the removal of pathogenic substances, such as antibodies, immune complexes, or 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 separately. (See "Therapeutic plasma exchange: Indications" and "Therapeutic plasma exchange: Complications".)


In general, large molecular weight compounds equilibrate slowly between the vascular space and the interstitium. Thus, calculations of the rate of removal by therapeutic plasma exchange (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 in a single treatment 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 log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Jan 16, 2014.
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 ©2014 UpToDate, Inc.
  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. 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.
  6. Leitman SF, Ciaverella D, McLeod B, et al. Guidelines for Therapeutic Hemapheresis, American Association of Blood Banks, Bethesda 1994.
  7. Therapeutic Apheresis, Kolins J, Jones JM (Eds), American Association of Blood Banks, Arlington 1983. p.2.
  8. Keller AJ, Urbaniak SJ. Intensive plasma exchange on the cell separator: effects on serum immunoglobulins and complement components. Br J Haematol 1978; 38:531.
  9. 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.
  10. Technical Manual, 11th ed, Walker RH (Ed), American Association of Blood Banks, Bethesda 1993. p.37.
  11. 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.
  12. 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.