What is Plasmapheresis?
Plasmapheresis, also called Therapeutic Plasma Exchange (TPE), is a procedure in which a patient’s blood is removed from the body, the plasma portion is separated and discarded, and the remaining blood components (red blood cells, white blood cells, and platelets) are returned to the patient along with replacement fluid.
The purpose is to remove harmful substances present in the plasma, such as:
- Autoantibodies
- Immune complexes
- Cryoglobulins
- Toxins
- Excess proteins
Common Indications
Plasmapheresis is used in conditions such as:
- Guillain-Barré Syndrome
- Myasthenia Gravis (myasthenic crisis)
- Thrombotic Thrombocytopenic Purpura
- Goodpasture Syndrome
- Multiple Sclerosis (selected cases)
- Systemic Lupus Erythematosus (selected severe cases)
- Hyperviscosity syndromes
Types of Plasmapheresis
1. Therapeutic Plasma Exchange (TPE)
- Plasma is removed and discarded.
- Replacement fluid is infused.
2. Donor Plasmapheresis
- Plasma is collected from healthy donors.
- Blood cells are returned to the donor.
Nursing Responsibilities and Procedure
Before the Procedure
1. Patient Assessment
Assess:
- Vital signs (BP, pulse, respiration, temperature)
- Weight
- Fluid balance
- Medical diagnosis and indication
- History of bleeding disorders
- Allergies
- Current medications
2. Review Laboratory Values
Check:
- Complete Blood Count (CBC)
- Platelet count
- PT/INR and aPTT
- Serum electrolytes
- Calcium level
- Blood grouping if plasma replacement is planned
3. Vascular Access Assessment
Ensure patency of:
- Central venous catheter (commonly used)
- Double-lumen catheter
- Large peripheral veins if appropriate
4. Patient Education
Explain:
- Purpose of the procedure
- Duration (usually 1–3 hours)
- Possible sensations:
- Cold feeling
- Tingling around mouth or fingers
- Lightheadedness
5. Obtain Consent
Verify informed consent according to institutional policy.
During the Procedure
Nursing Care
Monitor Vital Signs
- Before procedure
- Every 15–30 minutes during treatment
- After completion
Watch for:
- Hypotension
- Tachycardia
- Arrhythmias
Observe for Citrate Toxicity
Anticoagulant citrate binds calcium and may cause:
Symptoms:
- Perioral tingling
- Finger numbness
- Muscle cramps
- Tetany
Action:
- Notify physician immediately.
- Administer calcium supplementation if prescribed.
Monitor Vascular Access
Assess for:
- Bleeding
- Infection
- Catheter malfunction
- Air embolism
Observe for Adverse Reactions
- Allergic reactions
- Chills
- Fever
- Dyspnea
- Urticaria
Maintain Strict Asepsis
- Hand hygiene
- Sterile catheter care
- Infection prevention measures
After the Procedure
Assessment
Monitor:
- Vital signs
- Neurological status
- Bleeding from access site
- Signs of infection
Laboratory Monitoring
Review:
- CBC
- Platelets
- Electrolytes
- Calcium levels
- Coagulation profile
Access Site Care
Inspect for:
- Hematoma
- Oozing
- Redness
- Swelling
Documentation
Record:
- Date and time
- Volume exchanged
- Type of replacement fluid used
- Patient response
- Complications
- Nursing interventions
Possible Complications
| Complication | Nursing Observation |
|---|---|
| Hypotension | Dizziness, low BP |
| Citrate toxicity | Tingling, cramps, tetany |
| Bleeding | Oozing, bruising |
| Infection | Fever, redness at catheter site |
| Allergic reaction | Rash, itching, dyspnea |
| Electrolyte imbalance | Weakness, arrhythmias |
| Air embolism | Sudden dyspnea, chest pain |
Replacement Fluids Used
- 5% Albumin solution (most common)
- Fresh Frozen Plasma (FFP)
- Combination of albumin and saline
- Disease-specific replacement solutions
Key Nursing Points for Exams and Practice
- Verify indication and informed consent.
- Monitor vital signs closely throughout treatment.
- Watch for citrate-induced hypocalcemia (a common complication).
- Maintain sterile technique with vascular access.
- Monitor for bleeding and allergic reactions.
- Document procedure details and patient response accurately.
In one sentence: Plasmapheresis is a therapeutic procedure that removes a patient’s plasma containing harmful substances and replaces it with albumin or plasma, while nurses are responsible for assessment, monitoring, vascular access care, complication detection, and patient education throughout the process.