Plasma exchange (plasmapheresis)

Plasma is the liquid part of the blood. Plasma cells make proteins called antibodies (immunoglobulins). In some conditions, abnormal plasma cells make large amounts of immunoglobulin. This makes the blood thicker than normal and can cause symptoms such as fatigue, headaches, or blurred vision.

Plasma exchange (also called plasmapheresis) 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 extra proteins.

In this treatment, blood is extracted through a cannula in a vein in your arm. The abnormal plasma is then separated out by a machine and replaced with a plasma substitute. The blood is then returned to your body through a cannula in a vein in your other arm.

The treatment has few side effects, but you may feel light-headed or faint, or experience tingling or numbness in the fingers, mouth or nose. These symptoms can be treated easily. The procedure takes about two hours.


Plasma is a yellow fluid that is the liquid part of the blood. It transports blood cells, proteins and other substances around the body.

Plasma exchange (plasmapheresis)

Plasma exchange is a procedure during which your blood is separated into its different parts: red cells, white cells, platelets and plasma. The plasma is removed from the blood and a plasma substitute returned in its place.

Why plasma exchange is done

Plasma cells are a type of white blood cell. In conditions such as myeloma and Waldenström’s macroglobulinaemia, abnormal plasma cells may make large amounts of a protein called immunoglobulin. Very high levels of immunoglobulin in the blood can cause the blood to become thicker than normal which causes symptoms such as headaches, blurred vision and tiredness. This is sometimes called hyperviscosity syndrome.

Plasma exchange 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.

People with acute or chronic myeloid leukaemia who have a very high white blood cell count may sometimes need plasma exchange to reduce the number of white blood cells in their blood.

How plasma exchange is done

Plasma exchange is carried out using a machine called a cell separator, which separates blood cells and plasma. A short, thin tube (a cannula) is put into a vein in each arm. Blood is taken from a vein in one of your arms and circulated through the cell separator. This removes the plasma. The rest of your blood is returned to you through the vein in your other arm. To replace the plasma that is removed, a plasma substitute is given with the returned blood cells. As blood is being taken from you and returned to you at the same rate, only a small amount (less than 100ml) of blood is outside your body at any time.

Each plasma exchange takes about two hours. The rate of plasma exchange is decided according to your height, weight and the thickness (viscosity) of your blood.

The number of plasma exchanges that you need will depend on the amount of protein in your blood, your symptoms and your response to other treatments such as chemotherapy.

Possible side effects of plasma exchange

Feeling faint or light-headed 

Occasionally you can feel faint or light-headed during plasma exchange. If this happens, tell your nurse or doctor immediately. It’s usually easy to treat by changing your position so that you are lying down. You may be given additional fluid into the vein. 

Try to eat breakfast and lunch on the day of treatment as this can help to reduce your chances of feeling faint. 

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 temporarily affect the levels of calcium in your blood and cause the above symptoms. 

Let the nurse or doctor know straight away if you feel numbness or tingling sensations. It's easy to treat them by giving you a milky drink or calcium tablets, or by pausing the plasma exchange for five minutes. This is usually enough time for your body to readjust to the effects of citrate and for the symptoms to go away.

Additional information

If anything is worrying you about the procedure, speak to the nurse or doctor carrying out the treatment as they may be able to help. If you are anxious about needles, for example, it may be possible to have a local anaesthetic cream applied to numb the skin where the needles are put in.

You may want to bring in magazines or a book to help pass the time. You can usually have a relative or friend with you during the procedure.

Drinking plenty of fluids (2–3 litres) on the day of the treatment will help to replace any fluid that you may have lost during the procedure. You may also want to avoid alcohol for the rest of the day, as its effect on the body will be stronger than usual.

Some medicines can affect plasma exchange. Let your doctor or nurse know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Once plasma exchange begins, it is difficult to move around, so you may want to go to the toilet before the treatment starts.

People often feel very tired after the procedure and you may feel tired for the rest of the day. It is best to rest afterwards and avoid physically strenuous activity. It is also a good idea to arrange someone to take you home after treatment, rather than to drive home yourself.

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