Plasma exchange plasmapheresis

Plasmapheresis is the therapeutic removal of plasma from the peripheral blood usually carried out by a cell separator machine. The removed plasma is replaced isovolaemically usually by albumin/saline combinations depending on indication, plasma albumin level and frequency of exchange. Blood products may also be given as part of replacement which is useful in patients with fluid intolerance e.g. on renal dialysis. The exception to this is TTP where the replacement fluid is always FFP or cryosupernatant. —1 —1.5 x plasma volume is exchanged in each procedure, i.e. 2.5-4L for average adult. Procedure takes 2-4h depending on volume to be exchanged and the line flow rates. Procedure may need to be repeated daily until response e.g. TTP, or until a total volume exchange has been achieved e.g. 10—15L over 2 weeks (e.g. Guillain-Barré syndrome), or monthly to control hyperviscosity (e.g. Waldenstrom's macroglobuli-naemia).

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