Plasma exchange

Plasma is the liquid part of the blood. It contains blood cells and proteins.

Plasma exchange (plasmapheresis) is a way of separating plasma from blood cells using a machine called a cell separator. It is used to treat myeloma and a rare type of lymphoma called Waldenström's macro-globulinaemia.

In both of these conditions, abnormal plasma cells can make large amounts of a protein called immunoglobulin. This makes the blood thicker than normal and can cause symptoms such as fatigue, headaches and blurred vision.

Plasma exchange can reduce the amount of abnormal protein in the blood. However, it does not stop the protein being produced so other treatments, such as chemotherapy, are needed.

Blood is taken through a plastic tube (cannula) from a vein in your arm. Plasma is separated out and replaced with a plasma substitute. The blood is then returned into your other arm.

The treatment has few side effects. You may feel light-headed or faint, or experience tingling or numbness in the fingers, mouth or nose. Rarely, an allergic reaction can happen. These can usually be treated easily.

What is plasma?

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 which separates your blood into its different parts: red cells, white cells, platelets and plasma. The plasma is removed from the blood and replaced by a plasma substitute.

Why plasma exchange is done

Plasma cells are a type of white blood cell. In conditions such as myeloma and Waldenström’s macroglobulinaemia, which is a rare type of lymphoma, abnormal plasma cells may make large amounts of a protein called immunoglobulin. Very high levels of immunoglobulin in the blood can cause it to become thicker than normal. This can cause symptoms such as headaches, blurred vision and tiredness (fatigue). It 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 myeloid leukaemia or chronic myeloid leukaemia may sometimes have a very high number of abnormal white cells in their blood. They can be treated using leukapheresis, which is a similar procedure to plasma exchange. During leukapheresis, the white cells are removed instead of the plasma.

How plasma exchange is done

Plasma exchange is done 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 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 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 might 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.

Tell your doctor if you take tablets to help control your blood pressure. They may ask you to stop taking them temporarily.

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 lower 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.

You may be given a calcium tablet before starting plasma exchange if the amount of calcium in your blood is slightly low.

Allergic reaction to the replacement plasma

Rarely, plasma exchange 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
  • flushing
  • fever and chills.

Tell the nurse straight away if you notice any of these symptoms. The plasma exchange may be stopped while the reaction is treated.

Additional information about plasma exchange

If anything is worrying you about the procedure, speak to the nurse or doctor giving you the treatment as 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.

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 to 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 any strenuous activity. It is also a good idea to arrange someone to take you home after treatment, rather than drive home yourself.

Back to Supportive therapies

Blood transfusions

Some cancers or cancer treatments can cause anaemia, which is a low number of red blood cells. Blood transfusions are used to treat anaemia.


Erythropoietin (EPO) is used to treat anaemia caused by cancer or its treatment.


Granulocyte-colony stimulating factor (G-CSF) is a type of biological therapytreatment called a growth factor. This helps your body make more white blood cells.


A nephrostomy is a tube that drains urine from the kidney if there is a blockage in the urinary system.

Platelet transfusions

Platelets are cells that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets and you may need a platelet transfusion.


Steroids can be used as part of cancer treatment, or to help with the side effects of treatment.