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Therapeutic plasma exchange: Prescription and technique

INTRODUCTION

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".)

PRESCRIPTION

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.

       

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Literature review current through: Jul 2014. | This topic last updated: Jan 16, 2014.
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References
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