Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Plasma is the part of the blood that is left when red blood cells, white blood cells, and platelets have been removed. Plasma makes up about 55 percent of blood and contains water, salts, enzymes, antibodies, and other types of proteins. Plasma helps the body clot blood and fight infection, among other jobs.1

What is plasmapheresis?

Plasmapheresis (plaz’ ma pha ree’ sis) is a type of transfusion in which a person’s plasma is removed and replaced with plasma from a healthy donor or other fluid. It is sometimes called ‘plasma exchange.’

How does plasmapheresis work?

The idea behind plasmapheresis is that the plasma of a person with lupus contains immune complexes and autoantibodies that attack the body’s healthy tissue. Plasmapheresis replaces that unhealthy plasma with healthy plasma. In most cases, 2 to 3 liters of plasma is removed and replaced with either a saline-protein solution or plasma from healthy donors.

When is plasmapheresis used in people with lupus?

Years ago, plasmapheresis was used fairly often to help combat severe complications of lupus, such as kidney nephritis, thrombocytopenia (low platelet count), recurrent bleeding in the lungs, antiphospholipid syndrome, or complications of the central nervous system such as transverse myelitis (inflammation of the spinal cord) or brain abscess.

Today, it is recommended less often and only for a few serious complications of the central nervous system and recurrent bleeding in the lungs.2 Plasmapheresis was used in less than 10 percent of intensive care patients with lupus, according to a 2013 study from Poland.3

Side effects of plasmapheresis

The most common side effects of plasmapheresis were usually mild and temporary, and included:

  • A drop in arterial blood pressure
  • Arrhythmia (irregular heartbeat)
  • Sensations of cold followed by heat
  • A prickling or tingling sensation

Risks of plasmapheresis

Plasmapheresis carries risks, including death due to respiratory or cardiac complications. Common complications include serious cardiac arrhythmias, pulmonary edema, respiratory distress, blood clots, infections or an increased risk of bleeding.4-5

When donor plasma is used, there is a risk of allergic reactions, anaphylaxis, and transfusion-related acute lung injury (TRALI). Plasma from donors may also increase the risk of transfusion-transmitted disease.4-5

Plasmapheresis is a complex and expensive treatment and its uses in people with lupus have not been closely studied in large numbers of patients. Therefore, doctors tend to try this treatment only when medicines and other treatments have failed or cannot be used.

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