Plasma Exchange

Information for patients and families undergoing plasma exchange

This leaflet has been especially written for patients who are about to undergo plasma exchange. We hope the leaflet and a discussion with the medical and nursing staff will help you to understand this safe, simple, and routine procedure and what it involves.

What is Plasma?

Plasma is the fluid portion of the blood that allows the circulation of red blood cells, white blood cells, and platelets. Consisting mainly of water in which numerous compounds are dissolved, it is a clear straw coloured liquid. Plasma also makes possible chemical communication between different parts of the body by carrying proteins, minerals, hormones, vitamins, and antibodies.

What is Plasma Exchange?

Plasma Exchange is a procedure involving the separation and removal of the plasma from the blood in order to remove abnormal substances circulating in the plasma. The red blood cells, white blood cells, and platelets are returned to the patient, along with a prescribed replacement fluid such as Human Albumin Solution or fresh frozen plasma. Simply stated, the “old plasma” is removed and replaced by the “new plasma.”

Why is Plasma Exchange Necessary?

This depends upon your diagnosis. For example, some diseases create substances which circulate throughout the body in the plasma portion of the blood. In some cases these substances are called “autoantibodies,” which attack healthy cells or tissue. These autoantibodies are created by a mix-up in the body’s immune system. In other diseases there is an overproduction of protein which results in thickening of the blood, slowing down the blood flow. Your doctor will discuss with you whether plasma exchange would be useful in your specific case.

How is the plasma exchange performed?

Plasma exchange is performed on a machine called a blood cell separator which uses a centrifuge to separate plasma from the cells of the blood. Trained nursing staff operate the blood cell separator and monitor the condition of the patient at all times.

The cell separator works continuously using sterile tubing sets and needles which are used one time only and then discarded. Blood is drawn from a patient’s arm vein or central line through a needle attached to a blood tubing set. A medicine (anticoagulant) is added to the blood to keep it from clotting. The blood flows through the machine which separates the plasma and collects it into a bag. Your plasma is replaced with new plasma and returned through a second needle into the other arm or central line.

A plasma exchange usually takes between one to two hours. The number of plasma exchanges depends upon the nature of the illness and will be decided by your doctor.

For patients with difficult or small veins or for patients requiring a series of plasma exchange procedures a special intravenous catheter may be inserted into one of the neck veins. This catheter will be inserted prior to the plasma exchange and will allow blood to be taken from you via one of two lumens into the cell separator and the processed blood returned via the second lumen. It will remain in place until you have finished the series of plasma exchange procedures.

Side Effects

1. Although the machine contains only a small proportion of your blood, some patients feel faint, dizzy or light-headed. Patients should immediately tell the nursing staff if they begin to feel uncomfortable.
2. The anticoagulant used to keep the blood from clotting and certain types of replacement fluids may cause a sour taste in the mouth, tingling around the lips, or a tingling sensation/numbness in the fingers or toes. Please tell the nursing staff if they have any of these symptoms. You may then be given a chewable tablet of calcium, milk or an infusion (drip) of calcium.
3. Occasionally patients may have an allergic reaction to the “new” replacement plasma and may develop a rash or high temperature.
4. Plasma contains factors which help the blood to clot. Multiple plasma exchange procedures may reduce the levels of these factors, this is monitored closely. If the levels drop too low, the next plasma exchange may be delayed to allow the body to replenish these. Your medical team may decide that it is important not to miss an exchange and prescribe blood products containing these clotting factors called cryoprecipitate or fresh frozen plasma as the “new” replacement plasma.
5. The use of any blood product carries a potential risk of disease transmission. The replacement fluid Human Albumin Solution is manufactured from donated blood and although it is sterile, the possibility of it passing on an infection cannot be totally ruled out. There are no reported cases of viral infections being transmitted from albumin manufactured to European specifications.¹

Fresh Frozen Plasma and Cryoprecipitate are products that have been separated from donated blood by the National Blood Service and do not go through a manufacturing process. In the United Kingdom all blood donors are unpaid volunteers who go through a strict screening process about their health. Before donation, every effort is made to identify and exclude all those whose blood may carry a risk of passing on infections. In addition, every unit of donated blood is individually tested. Any blood which fails these rigorous tests is discarded and the donor advised. The testing process is regularly monitored to ensure that the highest standards are maintained.

The chance of contracting hepatitis from a blood transfusion is currently about one in 500,000 for hepatitis B and one in 30 million for hepatitis C. The chance of contracting HIV or HTLV infection is one in 5 million2. The level of risk of contracting variant Creutzfeldt-Jakob disease (vCJD) is not known, but is likely to be extremely low. Each year approximately two million units of blood are transfused in England and there have been just a handful of cases where patients are known to have become infected with vCJD from a blood transfusion. The National Blood Service actively reviews research into vCJD and, based on this, puts into place strategies to further reduce this potential risk2. Fresh frozen plasma & cryoprecipitate are known causes of a potentially life threatening complication called Transfusion related Acute Lung Injury (TRALI), the incidence of which is reported as being between 1 in 5,000 and 1 in 10,000.

Other Frequently Asked Questions

Q. Will there be any pain?

A. The initial insertion of the needles into the arms may cause some discomfort. The needles have to remain in place during the procedure (about one and a half to two hours). Keeping the arms in one position and staying relatively still, may be uncomfortable.

Q. Is Plasma Exchange safe?

A. Approximately 300,000 plasma exchange procedures are performed worldwide each year with few problems. Another one million procedures, which are similar to plasma exchange, are performed each year on volunteer donors to collect plasma and platelets, again with few problems.

Q. Are there any reactions or lasting side effects?

A. Some patients feel tired after a plasma exchange procedure and require rest. Side effects during the procedure might include feeling dizzy, light-headed, nauseated, and cold. Some patients may feel tingling in the fingers and around the mouth. It is extremely important for patients to notify the nursing staff immediately if they feel these symptoms or feel uncomfortable. The nursing staff can slow down or stop the procedure for a short time before deciding whether to continue.

Q. How long does a Plasma Exchange take?

A. A single procedure usually takes between one and two hours.

Q. Are patients left on their own?

A. No. The nursing staff will be there all the time.

Q. Can a patient have something to eat or drink during a procedure?

A. There is generally no reason why most patients can’t eat or drink during the procedure. If needles in the arms rather than an intravenous catheter in the neck are being used then arm movement will be restricted. A patient should drink some fluids and use the bathroom before the procedure begins.

Q. Can a patient have visitors?

A. Once the procedure is under way, you are usually allowed visitors.

Q. Do I need to fast before plasma exchange?

A. No

If there are any other questions you would like to have answered, ask the medical or nursing staff.

Contacts/Further information

For further information please contact the Apheresis Unit on 01223 256272 (ext. 56272).

References/Sources of evidence

1. Information Leaflet for Human Albumin 50g/L Baxter Healthcare. Oct.2006
2. Patient Information ‘Your questions about blood transfusion answered’ a leaflet for patients and their relatives. Addenbrooke’s Hospital