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Plasmapheresis
 

Today, plasmapheresis is widely accepted for the treatment of myasthenia gravis, Lambert-Eaton syndrome, Guillain-Barré syndrome, chronic demyelinating polyneuropathy, hyperviscosity syndrome, leukostasis syndrome, Goodpastures syndrome, cryoglobulinemia, thrombotic thrombocytopenic purpura/hemolytic uremic syndrome, familial hypercholesterolemia. In addition, its use has been considered for numerous other diseases, some of which are undergoing additional investigation. Nephrology Associates of Kentuckiana oversees the process of plasmapheresis for many treatments of conditions requiring this procedure.

One of the conditions currently under investigation is using plasmapheresis to allow kidney transplants between incompatible pairs. While this is not currently being performed in our immediate area, patients of Nephrology Associates of Kentuckiana, PSC have been referred to regional transplant centers that offer such approaches.

Ideally, a kidney transplant takes place between a donor and recipient who have the same or compatible blood type; however, more than one-third of willing live donors are turned down because their blood types are not compatible with the person to whom they wish to donate their kidney. With a kidney transplant, if the kidney is donated by an individual who has a different blood type than the recipient, the body will automatically create antibodies to combat the "foreign body" (the new kidney) and therefore the transplant would fail.

In the 1970s, researchers and the Muscular Dystrophy Association developed a new approach to remove these antibodies through a mechanical process known as "plasmapheresis." Plasmapheresis began being used in kidney transplant recipients in the 1980's.

"Many of these patients have repeatedly been told there is no hope of ever receiving a kidney transplant," says Robert A. Montgomery, M.D., D.Phil., Professor of Surgery, Director of the Incompatible Kidney Transplant Program, Chief of the Division of Transplantation, and Director of the Comprehensive Transplant Center, at the Johns Hopkins University and Hospital. "With this innovation, I can tell any patient who has a live donor and is medically eligible that they can be transplanted with a high likelihood of success. This procedure has the potential of increasing the number of living donor transplant operations by one-third to one-half."   [TOP]

FAQ about Plasmapheresis

 

How do I know if plasmapheresis will work for me?
The process involves testing the proposed recipient to assess the risk of rejection from harmful antibodies. Next the recipient undergoes plasmapheresis, a process involving the removal of the plasma portion of the blood that contains harmful antibodies and the administration of a medication to prevent their production. The patient is then ready to undergo transplant surgery where, in addition to receiving a donor organ, the patient's spleen is removed using minimally invasive surgical techniques. In some cases, spleen removal can be avoided through the use of a new drug that creates similar effects.

Post transplant, the patient undergoes additional plasmapheresis treatments before being discharged from the hospital. He or she will then take the same immunosuppression medications as patients receiving a compatible kidney.
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How long does Plasmapheresis take?
An average course of plasma exchanges is six to 10 treatments over two to 10 weeks. The time spent on the machine may be one to three hours. This depends upon the patient’s weight, height and the amount of plasma to be exchanged.
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How does plasmapheresis happen?
A person undergoing plasmapheresis can lie in bed or sit in a reclining chair. A small, thin tube (catheter) is placed in a large vein, usually the one in the crook of the arm, and another tube is placed in the opposite hand or foot (so that at least one arm can move freely during the procedure).

The basic procedure consists of removal of blood, separation of blood cells from plasma, and return of these blood cells to the body's circulation, diluted with fresh plasma or a substitute. Because of concerns over viral infection and allergic reaction, fresh plasma is not routinely used. Instead, the most common substitute is saline solution with sterilized human albumin protein. During the course of a single session, two to three liters of plasma is removed and replaced.

There are three procedures available:

  • "Discontinuous flow centrifugation." Only one venous catheter line is required. Approximately 300 ml of blood is removed at a time and centrifuged to separate plasma from blood cells.

  • "Continuous flow centrifugation." Two venous lines are used. This method requires slightly less blood volume to be out of the body at any one time.

  • "Plasma filtration." Two venous lines are used. The plasma is filtered using standard hemodialysis equipment. It requires less than 100 ml of blood to be outside the body at one time.   [TOP]


Are there risks associated with plasmapheresis?
Yes, but most can be controlled. Any unusual symptoms should be immediately reported to the doctor or the person in charge of the procedure.

The most common problem is a drop in blood pressure, which can be experienced as faintness, dizziness, blurred vision, coldness, sweating or abdominal cramps. A drop in blood pressure is remedied by lowering the patient's head, raising the legs and giving intravenous fluid.

Bleeding can occasionally occur because of the medications used to keep the blood from clotting during the procedure. Some of these medications can cause other adverse reactions, which begin with tingling around the mouth or in the limbs, muscle cramps or a metallic taste in the mouth. If allowed to progress, these reactions can lead to an irregular heartbeat or seizures.

An allergic reaction to the solutions used to replace the plasma or to the sterilizing agents used for the tubing can be a true emergency. This type of reaction usually begins with itching, wheezing or a rash. The plasma exchange must be stopped and the person treated with intravenous medications.

Excessive suppression of the immune system can temporarily occur with plasmapheresis, since the procedure isn't selective about which antibodies it removes. In time, the body can replenish its supply of needed antibodies, but some physicians give these intravenously after each plasmapheresis treatment. Outpatients may have to take special precautions against infection.
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SERVICES

Comprehensive Renal Care Clinic
Anemia Management
Hypertension Management
Plasmapheresis
Chronic Kidney Disease Education
Risk Factor Reduction
Use of Electronic Medical Record
Nutrition – Renal Vitamins

OUR MISSION

Is to provide the highest quality, most comprehensive and up-to-date care for patients with kidney disease in a courteous, respectful, and timely manner.

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Louisville, KY 40205
Phone: 502-587-9660
877-585-9660
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6400 Dutchmans Parkway  |  Louisville, KY  40205
502-587-9660  |  502-540-5615 fax

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