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Specialists in the Field of Plasmapheresis
Information About the Field of Plasmapheresis
In simple words: What exactly is plasmapheresis?
Plasmapheresis refers to a medical procedure that may be performed for two separate purposes:
- Preparative plasmapheresis: collection of donor plasma (plasma donation).
- Therapeutic plasmapheresis: removal of pathogenic (disease-causing) blood elements from the circulation.
Most of these pathogenic substances are proteins or antibodies that are dissolved in the blood plasma. Blood plasma represents the acellular, liquid portion of the blood and makes up about 55% of the total blood.
During plasmapheresis, blood is collected from the patient and separated into blood plasma and cellular components extracorporeally, meaning outside the human body, with the help of a plasmapheresis device. Depending on what form of plasmapheresis is applied, different procedures will follow.
Course of therapy: how does plasmapheresis work?
Preparative plasmapheresis (plasma donation):
During plasma donation, around 600 ml blood plasma are collected in one sitting.
Firstly, a vein has to be punctured and in most patients a vein of the arm is suitable. This is followed by the transport of blood to a plasmapheresis device via an infusion tube, where it is prepared outside the body (extracorporeal).
Depending on the type of device, the plasma is separated from the rest of the blood by either centrifugation or filtration. Once the plasma has been extracted, the remaining cellular blood components can be reintroduced into the patient’s circulation through a second infusion tube.
The collected blood plasma is frozen as soon as possible.
To avoid unwanted blood coagulation during plasmapheresis, patients are administered heparin before initiating the procedure.
The extracted plasma does not have to be replenished, as the body is capable to balance out the fluid loss spontaneously. The entire procedure takes around 30 – 70 minutes.
Therapeutic plasmapheresis (plasma exchange):
Therapeutic plasmapheresis involves exchanging the blood plasma.
Before starting this procedure, patients receive heparin, too.
To start with, blood plasma must be separated from cellular blood components. Just like with plasma donations, a vein is punctured and the patient’s blood is guided to a plasmapheresis device via an infusion tube, where blood separation takes place.
Cellular components are given back to patients at the end, as well. Non-specific and specific plasma exchange are two distinct techniques that can be distinguished during the further procedure.
Non-specific plasma exchange:
this involves exchanging the extracted blood plasma with a substitution solution (containg albumin or plasma constituents, among others). These must be delivered via infusion.
- Specific plasma exchange: With the help of special techniques (e.g. immune adsorption) certain antibodies can be selectively extracted. The cleansed blood plasma will be reintroduced into the patient’s circulation, therefore no significant plasma losses are encountered.
Indication: When is plasmapheresis used?
Preparative plasmapheresis is indicated, whenever plasma donations are needed.
Therapeutic plasmapheresis, on the other hand, is used for the treatment of various diseases, as described in more detail in the following passage:
Non-selective plasmapheresis is used whenever certain components of the blood plasma are structurally altered or present in abnormally high numbers. This can be the case in the following conditions:
- Thyroid storm: life-threatening worsening of hyperthyroidism
- Waldenstrom macroglobulinemia: a B-cell Non-Hodgkin lymphoma (type of lymphatic cancer )
- Thrombotic-thrombocytopenic purpura (TTP): small blood coagulations and thrombocyte deficiency leading to neurologic deficits, bleedings and hemolytic anemia
- Atypical hemolytic uremic syndrome (HUS): combination of kidney damage up to failure, thrombocyte deficiency, hemolytic anemia and damage to small blood vessels
- Hepatopulmonary syndrome: distortion of gas exchange in the lung with oxygen deficiency in arterial blood with concomitant liver disease
- Schnitzler syndrome: combination of chronic urticaria, arthralgia and elevated IgM antibodies
Selective plasmapheresis is used to treat autoimmune disease. These include:
- Guillain-Barré syndrome: neurologic disease resulting from enhanced autoimmune reaction (most often following an infection) with damage to the myelin sheath of peripheral nerves, which causes palsy
- Multiple sclerosis : inflammation of the nervous system with destruction of nerve tissue
- Myasthenia gravis: autoimmune disorder which involves a defective signal transduction between nerve and muscle, resulting in muscular weakness
- Goodpasture syndrome: autoimmune destruction of lung and kidney tissue
- Complications associated with Lupus, such as antiphospholipid syndrome: thrombophilia resulting in an increased risk for thrombosis
- Autoimmune hemolytic anemia: anemia due to antibody-related destruction of red blood cells
- Different kinds of glomerulonephritis: inflammation of the glomeruli of the kidneys
How much does the treatment cost?
The costs for one sitting are approximately 500-800 Euros. In general, health insurance companies do not cover the costs outpatient plasmapheresis.
What side effects can occur?
Complications with plasmapheresis are very rare.
However, possible complications may include:
- Infections of the venous puncture site
- Increased tendency to bleed due to anticoagulation during plasmapheresis (by medications such as heparin)
- Allergic reactions (e.g. to components of the substitution solution)
- Disorders of the cardiovascular system (e.g. blood pressure drop) resulting from blood loss
Which clinics and doctors specialize in plasmapheresis?
Patients in need of plasmapheresis obviously strive for the best possible medical care. This leads to the question of where to find the best clinic to carry out plasmapheresis.
Usually nephrological departments of hospitals offer plasmapheresis. These are departments that specialize in the treatment of kidney disorders. When it comes to the treating physicians, it should be emphasized that they have sufficient experience in plasmapheresis and carry out this procedure on a regular basis.
If you're in need of a doctor, you expect the best possible medical care. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.
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