Plasmapheresis (PLEX)
Mechanism
- Blood is filtered to remove plasma -> replaced with albumin/donor plasma/saline -> blood cells are returned to the body
'PV = (1 – Hct) × TBV'
'TBV (L) = 0.07 × weight (kg)
- 1 session 1-1.5PV exchange, and removes 63% mediators
- citrate is used as AC, so check calcium
Indications
- MG crisis
- GBS
- NMSOD
- AIE
- MS steroid resistant
Timing
- 3 to 7 sessions every other day (MC protocols)
> less, but will need repeat later
> daily, if protocolated
Protocol
- call IR to place CVA (shiley), hem-onc for PLEX and replacement therapary (BioBank)
- short note
> daily PT, PTT, Fibrinogen, CBC, Calcium levels and metabolic panel
- common side effects
> tingling in mouth and hands 2/2 calcium
> neck discomfort 2/2 shiley