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Plasmapheresis

Plasmapheresis, or plasma exchange, is a medical procedure designed to remove and replace plasma in the blood, often used for treating specific kidney diseases and other conditions. Here’s a detailed look at its key aspects:

Procedure Overview:

  1. Objective:
    • The main goal is to remove harmful substances, such as antibodies, from the plasma that can damage organs or interfere with treatment.
  2. How It Works:
    • Blood is drawn from the patient and passed through a special dialyzer, which separates the plasma from the blood cells.
    • The plasma is then discarded or treated, and replaced with fresh frozen plasma, albumin, or saline.
    • Blood cells are returned to the patient along with the replacement fluid.
  3. Equipment Used:
    • Dialyzer: A specialized filter that separates plasma from blood cells.
    • Blood Pump: Moves the blood through the system.
    • Vascular Access: Typically involves an internal jugular catheter, femoral vein catheter, AV fistula, or AV graft.
    • Anticoagulation: Medications used to prevent clotting during the procedure.
  4. Setting:
    • Usually performed in an Intensive Care Unit (ICU) or specialized dialysis center due to its complexity and need for continuous monitoring.

Conditions Treated with Plasmapheresis:

  1. Anti-GBM Disease:
    • A condition where the body’s immune system attacks the glomerular basement membrane in the kidneys.
  2. Hemolytic Uremic Syndrome (HUS) / Thrombotic Thrombocytopenic Purpura (TTP):
    • Conditions characterized by blood clot formation in small blood vessels, leading to kidney failure and other complications.
  3. Cryoglobulinemia:
    • Presence of abnormal proteins in the blood that can cause kidney damage and other issues.
  4. Vasculitis:
    • Inflammation of blood vessels, which can affect multiple organs including the kidneys.
  5. Recurrent Focal Segmental Glomerulosclerosis (FSGS):
    • A form of kidney disease that can recur in kidney transplant recipients.
  6. Sensitised Patients Awaiting Kidney Transplant:
    • Patients with high antibody levels that may cause rejection of a new kidney.
  7. Antibody-Mediated Rejections:
    • Post-transplant rejection caused by antibodies attacking the transplanted organ.

Benefits:

  1. Relieves Symptoms of Autoimmune Disorders:
    • Conditions like Guillain-Barre syndrome and myasthenia gravis can see symptom relief.
  2. Removes Harmful Substances:
    • Helps in eliminating substances that could be harmful to the body.
  3. Organ Transplants:
    • Reduces antibody levels in sensitized patients, preventing rejection of transplanted organs and treating antibody-mediated rejection.
  4. Rapidly Progressive Renal Failure:
    • Effective in treating some forms of acute kidney failure due to autoimmune causes.

Potential Risks and Side Effects:

  1. Infection:
    • Risk associated with the insertion of catheters and the transfer of blood.
  2. Blood Clotting:
    • Risk of bleeding due to removal of clotting proteins; anticoagulants are used to manage this.
  3. Allergic Reactions:
    • Possible reaction to replacement fluids or medications.
  4. Electrolyte Imbalance:
    • Imbalance of minerals in the blood due to fluid replacement.
  5. Drop in Blood Pressure:
    • Can occur during the procedure due to fluid shifts and volume changes.

Consultation:

If you are considering plasmapheresis for treatment, it’s essential to discuss your condition and treatment options with a healthcare professional. They can provide personalized advice based on your specific health needs and the potential benefits and risks of the procedure.