Plasma exchange

The anti-acetylcholine receptor antibody is in the IgG fraction of the plasma. The level of the antibody can be rapidly reduced by plasma exchange. A common course would be five daily sessions with 2 to 3 liters of plasma being removed at each exchange and replaced by a plasma substitute. Improvement in the clinical state may be seen within 3 days of the start of plasma exchange and improvement is optimal by about day 10. The benefit may be maintained for a month or more but is not sustained. Repeated courses are often needed to bolster improvement while waiting for other forms of immunosuppression to have an effect. The technique is often useful to achieve an optimal clinical state prior to thymectomy.

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