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Plasma exchange (plasmapheresis) is a treatment which separates your blood into its different parts:
- red blood cells
- white blood cells
The plasma is removed from the blood and replaced by a plasma substitute.
Leukapheresis is similar to plasma exchange but the white cells are removed instead of the plasma. We have more information about leukapheresis and when it is used.
Plasma cells are a type of white blood cell. In conditions such as myeloma and Waldenström’s macroglobulinaemia (a rare type of lymphoma), abnormal plasma cells may make large amounts of a protein called immunoglobulin.Immunoglobulin is also called a paraprotein.
Very high levels of immunoglobulin in the blood can cause it to become thicker than normal. This is sometimes called hyperviscosity syndrome. It can cause symptoms such as:
- blurred vision
- abnormal bleeding
Plasma exchange can be used to treat conditions such as myeloma and Waldenström’s macroglobulinaemia.
During plasma exchange, plasma is removed from the blood and replaced by a plasma substitute. This can reduce the amount of abnormal protein in the blood. However, it does not stop the protein being produced. Other treatments, such as chemotherapy, are needed to reduce the production of the protein by the plasma cells.
Plasma substitute is either plasma that has been treated to reduce the risk of viral infections, or human albumin solution. Both come from blood donors. The plasma substitute is sometimes mixed with other fluid, such as saline (a salt solution).
Before you have plasma exchange, your doctor will explain why it is being given. They may also give you information to read. You will be asked to give your permission (consent) for the hospital staff to do the plasma exchange. Medical treatment can only be given with your consent.
You may decide not to have plasma exchange. It is important to tell your doctor or nurse if you decide not to have treatment. They will record your decision in your medical notes.
You do not have to give a reason, but it can be helpful to tell the staff your concerns, so they can give you the best advice.
Jehovah’s Witnesses may choose not to have some types of blood products. If this affects you, talk to your doctor about other treatments or ways of managing your condition.
You have a blood test immediately before the plasma exchange. A nurse checks your breathing rate and oxygen levels before the treatment. They also check your blood pressure, pulse and temperature before, during and after the treatment. If these tests do not show any problems, the treatment can start.
Plasma exchange is done using a machine called a cell separator, which separates blood cells and plasma.
A nurse puts a short, thin tube (cannula) into a vein in each arm. Blood is taken from one of your arms and circulated through the cell separator. This spins the blood to separate the plasma from the blood cells so that the plasma can be removed. The rest of your blood is then mixed with a plasma substitute and returned to you through the vein in your other arm.
During plasma exchange, only a small amount (less than 100ml) of blood is outside your body at any time. This is because blood is being removed and returned at the same rate.
Each plasma exchange takes about 2 hours. The rate of plasma exchange is decided based on your height, weight and the thickness (viscosity) of your blood. The number of plasma exchanges you need will depend on the amount of protein in your blood, your symptoms and your response to other treatments such as chemotherapy.
You may have a blood test after the treatment. This is to check if you need calcium tablets or other supplements. A blood test can also check how effective the treatment has been.
Feeling faint or light-headed
Sometimes you might feel faint or light-headed during plasma exchange. If this happens, tell your nurse or doctor straight away. Changing your position so that you are lying down usually helps with this. You may be given additional fluid into the vein.
You can eat and drink as normal. Try to eat breakfast and lunch on the day of treatment, as this can help to prevent you from feeling faint.
Tell your doctor if you take tablets to help control your blood pressure. They may ask you to stop taking them for a short time.
Numbness and tingling
You may feel numbness or tingling around your mouth and nose, or in your fingers, during the treatment. This is a side effect of a substance called citrate. Citrate is mixed with your blood to stop it clotting while it is outside your body. If the amount of citrate builds up, it can lower the levels of calcium in your blood for a time and cause numbness and tingling.
Tell the nurse or doctor straight away if you feel numbness or tingling sensations. They may give you a milky drink or calcium tablets, or pause the plasma exchange for 5 minutes. This is usually enough time for your body to readjust to the effects of citrate and for the symptoms to go away.
If the amount of calcium in your blood is slightly low, you may be given a calcium tablet before or after the plasma exchange.
Rarely, plasma substitute may cause an allergic reaction. Your nurse will check you for this. If you have a reaction, they will treat it quickly.
Signs of an allergic reaction can include:
- a rash
- feeling itchy
- feeling short of breath
- fever and chills.
Tell the nurse straight away if you notice any of these symptoms. They may stop the plasma exchange while the reaction is treated.
Talk to your nurse or doctor about any concerns
If anything is worrying you about the treatment, tell the nurse or doctor giving you the treatment. They may be able to help. For example, if you are anxious about needles, it may be possible to have a local anaesthetic cream to numb the skin where the needles are put in.
Tell your doctor about any medications you are taking
Wear loose clothing
When plasma exchange starts, you need to stay on the bed. You might find it comfortable to wear loose clothes or bring something suitable to change into.
Take a relative or friend with you, or a book or tablet
You may want to bring in magazines, a tablet or a book to help pass the time. You can usually have a family member or friend with you during the treatment.
Go to the toilet before treatment starts
Once plasma exchange begins, it is difficult to move around, so you may want to go to the toilet before the treatment starts. If you need the toilet during the treatment, you will need to use a bedpan or bottle.
Drink plenty of water
Drinking plenty of fluids (2 to 3 litres) on the day of the treatment will help to replace any fluid that you may have lost during the treatment. You may also want to avoid alcohol for the rest of the day, as its effect on the body will be stronger than usual.
Rest after your treatment and avoid driving home
You might feel very tired after the treatment, and for the rest of the day. It is best to rest afterwards and avoid any physical activity. It is also a good idea to arrange for someone to take you home after treatment, rather than drive home yourself.
Below is a sample of the sources used in our supportive treatment information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
NHS Blood and Transplant. Therapeutic Apheresis Services Patient Information Leaflet – Plasma Exchange Procedure. Available from: Therapeutic Apheresis Services - Microsoft (accessed July 2019)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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