This document outlines the plasmapheresis protocol at the New Mansoura General Hospital Nephrology Department in Egypt. It defines plasmapheresis as removing, treating, and returning blood plasma from circulation. Examples of diseases treated with plasmapheresis include idiopathic pulmonary fibrosis, Guillain-Barre syndrome, and thrombotic thrombocytopenic purpura. The procedure, complications, replacement solutions, and post-procedure care are described.

1. Ministry of Health
Dakahlia Medical diroctorate
New Mansoura General Hospital
Nephrology Department
Plasmapharesis Protocol
Dr. Osama El SayadDr. NevienNabih
Egyptian Fellowshipof nephrology
New Mansoura General Hospital
Assistant Specialist of nephrology
New Mansoura General Hospital
Dr. Osama El Shahat
Consultant of Nephrology
Head of nephrology department
New Mansoura General Hospital

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Plasmapheresis is the removal, treatment, and return of (components of)
blood plasma from blood circulation. In plasmapheresis or therapeutic
plasma exchange <TPE> large quantities of plasma are removed and
replaced with fresh frozen plasma, albumin and / or saline
Indication: Examples of diseases that can be treated with plasmapheresis:
 Idiopathic pulmonary fibrosis
 Guillain-Barre syndrome
 Miller Fisher syndrome[7]
 Chronic inflammatory demyelinating polyneuropathy
 Good pasture's syndrome
 Hyper viscosity syndromes:
o Cryoglobulinemia
o Paraproteinemia
o Waldenström macroglobulinemia
 Myasthenia gravis
 Thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic
syndrome
 Wegener's granulomatosis
 Lambert-Eaton Syndrome
 Antiphospholipid Antibody Syndrome (APS or APLS)
 Microscopic polyangiitis
 Recurrent focal and segmental glomerulosclerosis in the transplanted
kidney
 HELLP syndrome

3.  PANDAS syndrome
 Refsum disease
 Behcet syndrome
 HIV-related neuropathy[8]
 Graves' disease in infants and neonates
 Pemphigus vulgaris
 Neuromyelitis optica
 Multiple sclerosis
 Rhabdomyolysis
 Toxic Epidermal Necrolysis (TEN)
Procedure of plasmapheresis:
A: Centrifugal plasma separation : blood cells are separated during
centrifugation , there are two centrifugation methods Intermittent flow
device and continuous flow device
B: membrane plasma separation : plasma separators use membranes with a
molecular weight 3 million
Estimation of plasma volume:
There are several equations
1-The plasma volume is estimated 35- 40 ml kg. 35ml is applicable to the
patient with normal Hct value and 40 ml kg is applicable to the patient with
low Hct
2- there is a simplified method for predicting the estimated plasma volume is
{0.065 xweight( kg) x {1-Hct}
Choice of replacement solution:
A: albumin : its advantage there is no risk of hepatitis , stored at room
temperature , allergic reaction are rare, depletes inflammation mediators
, but its disadvantage as its very expensive and no coagulation factor
and no immunoglobulin
B: fresh frozen plasma: advantage : has coagulation factors and
immunoglobulin , its disadvantage : risk of hepatitis, HIV .
Allergicreaction.Hemolytic reaction

4. Complication of plasmapheresis:
Related to the vascular access
1-Hematoma
2-Pneumothorax
3-Retroperitoneal bleed
Related to the procedure
1-Hypotension: can be avoided by adjust volume balance and should measure
the blood pressure every half hour
2-Bleeding: can be treated by two unite of fresh frozen plasma at the end of
session
3-Edema
4-Loss of cellular element
5-Hypersensitivity reaction: can be avoided by premedication for the
sensitized individual
a: prednisone 50 mg orally 13 hours , 7hours , 1 hour before treatment
b. diphenhydramine 50 mg orally 1 hour before treatmen
c: ephedrine 25 mg orally 1 hour before treatment
Related to anticoagulation
1-Bleeding
2- Hypocalcemic symptom: can be treated by prophylactic 10% CaCl
during treatment
3-Arrhythmia: due to hypokalemia which can be avoided by ensure
serum potassium concentration of 4 mm in the replacement solution
4-Hypotension
5-Numbness and tingling
6-Metabolic alkalosis from citrate
Post procedure:
We should do serum calcium, serum k& CBC to the patient
The plasmapheresis technique is consider as immunosuppressive therapy so
the patient should be isolated.