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:
- Objective:
The main goal is to remove harmful substances, such as antibodies, from the plasma that can damage organs or interfere with treatment. - 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. - 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. - 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:
- Anti-GBM Disease:
A condition where the body’s immune system attacks the glomerular basement membrane in the kidneys. - 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. - Cryoglobulinemia:
Presence of abnormal proteins in the blood that can cause kidney damage and other issues. - Vasculitis:
Inflammation of blood vessels, which can affect multiple organs including the kidneys. - Recurrent Focal Segmental Glomerulosclerosis (FSGS):
A form of kidney disease that can recur in kidney transplant recipients. - Sensitised Patients Awaiting Kidney Transplant:
Patients with high antibody levels that may cause rejection of a new kidney. - Antibody-Mediated Rejections:
Post-transplant rejection caused by antibodies attacking the transplanted organ.
Benefits:
- Relieves Symptoms of Autoimmune Disorders:
Conditions like Guillain-Barre syndrome and myasthenia gravis can see symptom relief. - Removes Harmful Substances:
Helps in eliminating substances that could be harmful to the body. - Organ Transplants:
Reduces antibody levels in sensitized patients, preventing rejection of transplanted organs and treating antibody-mediated rejection. - Rapidly Progressive Renal Failure:
Effective in treating some forms of acute kidney failure due to autoimmune causes.
Potential Risks and Side Effects:
- Infection: Risk associated with the insertion of catheters and the transfer of blood.
- Blood Clotting: Risk of bleeding due to removal of clotting proteins; anticoagulants are used to manage this.
- Allergic Reactions: Possible reaction to replacement fluids or medications.
- Electrolyte Imbalance: Imbalance of minerals in the blood due to fluid replacement.
- Drop in Blood Pressure: Can occur during the procedure due to fluid shifts and volume changes.