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plasmapheresis (plasma exchange)
Indications:
1) Guillain-Barre syndrome
2) chronic inflammatory demyelinating polyradiculopathy (CIDP)
3) myasthenia gravis
a) severe, prior to initiation of prednisone
b) preparation for thymectomy
4) thrombotic thrombocytopenic purpura (TTP)
5) cryoglobulinemia
6) glomerulomephritis
- ANCA-associated glomerulonephritis [1]
- granulomatous angiitis, Churg-Strauss syndrome
- anti-glomerular basement membrane disease [1]
- Goodpasture's syndrome
- recurrent segmental glomerulosclerosis
7) hyperviscosity syndrome
a) multiple myeloma
- myeloma cast nephropathy
b) Waldenstrom's macroglobulinemia
- IgM-related polyneuropathy
8) post-transfusion purpura
9) fulminant Wilson's disease [2]
10) Refsum's disease
11) paraprotein-associated polyneuropathy [1]
- Eaton-Lambert myasthenic syndrome
12) multiple sclerosis
13) antibody-mediated renal graft rejection [1]
14) clopidogrel or ticlopidine-associated thrombotic microangiopathy [1]
Complications:
common (up to 30%)
- hypocalcemia due to citrate anticoagulant
- hypotension (mild)
- allergic reactions
Management:
- stop ACE inhibitor 24 hours before elective apheresis [1]
Advantages:
- fast
Disadvantages:
- temporary
- expensive
General
apheresis
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 2018.
American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
- The Utility of Therapeutic Plasmapheresis for Neurological Disorders
NIH Consensus Statement
http://consensus.nih.gov/cons/056/056_intro.htm