Plasmapheresis (Therapeutic Plasma Exchange)

Plasmapheresis—also called therapeutic plasma exchange, TPE, or PLEX—is a type of apheresis procedure that replaces plasma, which may carry harmful substances in the blood. It works by separating plasma (the liquid part of your blood) from blood cells. The plasma, which may contain autoantibodies, inflammatory proteins, or toxins, can then be removed and replaced with albumin or healthy donor plasma which is returned to the patient’s circulation.

This treatment can restore balance in the immune system and reduce symptoms quickly in serious or rapidly progressing conditions. It’s performed in a controlled setting, often as part of a broader care plan managed by specialists in neurology, nephrology, transfusion medicine, hematology, or critical care.

Doctors recommend plasmapheresis when rapid removal of harmful elements in the blood is necessary. These substances may include autoantibodies, immune complexes, toxins, or abnormal proteins that contribute to disease. By exchanging the plasma, physicians can reduce inflammation, ease symptoms, and potentially prevent permanent organ damage.

This treatment is typically reserved for conditions where conventional therapies are ineffective or too slow to act. It’s often used in acute medical situations—such as a myasthenic crisis or rapidly progressing kidney failure—but may also be part of long-term disease management for certain autoimmune or neurologic disorders.

Plasmapheresis is used to manage a wide range of complex and immune-related conditions. It is especially helpful when the body produces harmful antibodies or proteins that affect the nerves, kidneys, blood, or other organs.

The conditions below are organized by the medical specialties that most often coordinate this treatment, such as neurology, nephrology, hematology, and transplant care.

Neurological Disorders

Plasma exchange helps reduce nerve inflammation or remove antibodies that attack the nervous system. At the University of Cincinnati Gardner Neuroscience Institute, conditions treated include:

• Guillain-Barré Syndrome (GBS)
• Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
• Myasthenia Gravis (especially during crisis)
• Multiple Sclerosis (severe relapses)
• Neuromyelitis Optica Spectrum Disorder (NMOSD)
• Autoimmune Encephalitis (e.g., anti-NMDA receptor)
• Lambert-Eaton Myasthenic Syndrome
• Stiff Person Syndrome
  
  

Antibody-Mediated Autoimmune Encephalitis and Related Conditions

Plasmapheresis may also support recovery in several rare neurological conditions linked to specific antibodies:

• Anti-IgLON5 Disease
• Anti-LGI1 or CASPR2 Encephalitis
• Anti-GAD65 Encephalitis
• Anti-GABA_B, AMPA, or mGluR5 Receptor Encephalitis
• Anti-DPPX Encephalitis
• Rasmussen’s Encephalitis
• Bickerstaff Brainstem Encephalitis
• Miller Fisher Syndrome
• Opsoclonus-Myoclonus Syndrome

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Hematologic & Blood Disorders

Used to remove abnormal antibodies or blood proteins, particularly in life-threatening situations:

• Thrombotic Thrombocytopenic Purpura (TTP)
• Atypical Hemolytic Uremic Syndrome (aHUS)
• Hyperviscosity Syndrome
• Cryoglobulinemia
• Sickle Cell Disease (some cases)
• Hemolytic disease of the newborn (rare)

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Renal (Kidney) Disorders

Supports kidney function by reducing immune attack on kidney tissues:

• Goodpasture’s Syndrome (Anti-GBM disease)
• Rapidly Progressive Glomerulonephritis
• Lupus Nephritis (select cases)
• ANCA-associated Vasculitis
• Focal Segmental Glomerulosclerosis (recurrent after transplant)

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Autoimmune & Connective Tissue Disorders

May reduce flares or treat life-threatening complications in:

• Systemic Lupus Erythematosus (SLE)
• Rheumatoid Arthritis (severe cases)
• Systemic Sclerosis (Scleroderma)
• Antiphospholipid Antibody Syndrome (catastrophic)

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Transplant & Rejection Management

Plasma exchange is not routinely used in all transplant cases, but it plays a critical role in certain high-risk or complex situations. It helps prepare or adjust the immune system before and after organ transplantation, including:

• Desensitization before kidney transplant
• Treatment of acute antibody-mediated rejection (AMR)
• ABO-incompatible organ transplants

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Dermatologic and Other Emerging Uses

In some cases, plasmapheresis supports treatment of:

• Pemphigus Vulgaris
• Bullous Pemphigoid
• Severe Dermatomyositis
• Toxic Epidermal Necrolysis
• Sepsis with organ failure
• Wilson’s Disease (acute liver failure)

Plasmapheresis is generally well-tolerated, but like any medical procedure, it carries some risks. Most side effects are temporary and manageable, especially when treatment is delivered by experienced teams.

Common Side Effects

• Low blood pressure during or shortly after treatment
• Fatigue or lightheadedness
• Low calcium levels, which may cause tingling or muscle cramps
• Mild allergic reactions to replacement fluids

Less Common Risks

• Infection risk, due to central line access or immune modulation
• Bleeding, as plasma exchange can affect clotting proteins
• Allergic or anaphylactic reactions to donor plasma (rare)

Patients are closely monitored before, during, and after treatment. UC Health teams adjust protocols to meet each person’s needs—including fluid replacement choices, timing of sessions, and management of underlying conditions. For many, the potential benefits of plasmapheresis outweigh the short-term risks, particularly in severe or rapidly progressing diseases.

Plasmapheresis is a vital treatment option for patients with immune-related, hematologic, or neurologic conditions that require rapid intervention. By removing harmful substances from the blood and replacing the plasma, this therapy can stabilize or significantly improve health outcomes.

At UC Health in Cincinnati, plasmapheresis is more than a standalone procedure—it’s part of a coordinated, multidisciplinary approach. Our care teams work together to evaluate each case and deliver treatment tailored to your condition and overall health.

With access to advanced laboratory services, specialized infusion teams, and the latest clinical protocols, patients receive plasmapheresis with safety, compassion, and precision.