What is Plasmapheresis
Plasmapheresis is a process in which the fluid part of the blood, called plasma,is removed from blood cells by a device known as a cell separator. The separator works either by passing the blood at high speed to separate the cells from the fluid or by passing the blood through a membrane with pores so small that only the fluid part of the blood can pass through. The cells are returned to the person undergoing treatment, while the plasma, which contains the antibodies, is discarded and replaced with other fluids. Medication to keep the blood from clotting (an anticoagulant) is given through a vein during the procedure.
An allergic reaction to the solutions used to replace the plasma or to the sterilizing agents used for the tubing can be a true emergency. This type of reaction usually begins with itching, wheezing or a rash. The plasma exchange must be stopped and the person treated with intravenous medications. Excessive suppression of the immune system can temporarily occur with plasmapheresis, since the procedure isnít selective about which antibodies it removes. In time, the body can replenish its supply of needed antibodies, but some physicians give these intravenously after each plasmapheresis treatment. Outpatients may have to take special precautions against infection.

Medication dosages need careful observation and adjustment in people being treated with plasmapheresis because some drugs can be removed from the blood or changed by the procedure.
Whatís involved in a plasmapheresis treatment?
A plasmapheresis treatment takes several hours and can be done on an outpatient basis. It can be uncomfortable but is normally not painful. The number of treatments needed varies greatly depending on the particular disease and the personís general condition. An average course of plasma exchange is six to 10 treatments over two to 10 weeks. In some centers, treatments are performed once a week, while in others, more than one weekly treatment is done.

A person undergoing plasmapheresis can lie in a bed or sit in a reclining chair. A small, thin tube (catheter) is placed in a large vein, usually the one in the crook of the arm, and another tube is placed in the opposite hand or foot (so that at least one arm can move freely during the procedure). Blood is taken to the separator from one tube, while the separated blood cells, combined with replacement fluids, are returned to the patient through the other tube.The amount of blood outside the body at any one time is much less than the amount ordinarily donated in a blood bank.
How long does it take to see improvement?

Improvement sometimes can occur within days, especially in myasthenia gravis. In other conditions, especially where there is extensive tissue damage, improvement is slower but still can occur within weeks.
"In Pakistan PMWO has been doing plasmapheresis at large for the rapid clinical management of patients with neuromuscular autoimmune disease (Myasthenia Gravis, GBS, CIDP, Polyneuropathy and others)"
Why PMWO prefer Plasmapheresis Treatment in Pakistan?

  1. Less Cost effective Treatment
  2. Satisfactory Clinical Results in patients treated with Plasmapheresis
  3. IVIG & Plasmapheresis both treatments having equal clinical effectiveness as reported by the International Medical Community and Health Institutions
  4. But IVIG is very expensive and patients in developing countries cannot afford the cost of IVIG.
  5. Trained and experts staff easily available with Mobile Plasmapheresis Service.

Are there risks associated with plasmapheresis?
Yes, but most can be controlled. Any unusual symptoms should be immediately reported to the doctor or the person in charge of the procedure.

Symptoms that may seem trivial sometimes herald the onset of a serious complication. The most common problem is a drop in blood pressure, which can be experienced as faintness, dizziness, blurred vision, coldness, sweating or abdominal cramps. A drop in blood pressure is remedied by lowering the patientís head, raising the legs and giving intravenous fluid.

Bleeding can occasionally occur because of the medications used to keep the blood from clotting during the procedure. Some of these medications can cause other adverse reactions, which begin with tingling around the mouth or in the limbs, muscle cramps or a metallic taste in the mouth. If allowed to progress, these reactions can lead to an irregular heartbeat or seizures.
Cost Comparison of Plasmapheresis with IVIG Treatment
Indications
IVIG Complete Therapy Cost
Plasmapheresis Cost

Myasthenia Gravis
GBS
Polyneuropathy
CIDP
MS
ITP
Others
IVIG used 1g / kg as standard dose and a patients with 60 kg weight required 60g IVIG treatment it will cost Rs.575,000/- for complete therapy @ 9,583.33 per IVIG injection.
05 sessions of Plasmapheresis within 10 days having the same effectiveness cost Rs.60,000/- @ 12,000/- Procedure.
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