Plasma Exchange

What is Plasma Exchange?

Plasma exchange is a procedure that separates the plasma (the liquid part of your blood) from the rest of your blood cells and replaces it with a replacement fluid. Plasma contains antibodies, proteins, and hormones that help regulate body functions. In liver disease, abnormal proteins or antibodies in the plasma can contribute to symptoms such as inflammation, fluid buildup, or other complications. Plasma exchange helps remove harmful substances and replaces them with donor plasma or a processed albumin solution, which may improve symptoms, although it doesn't cure the underlying condition.

This procedure may form part of your overall treatment plan, but it will not stop the body from producing abnormal proteins or antibodies. Ongoing treatment and monitoring will be necessary to manage your liver disease.

How is Plasma Exchange Performed?

The procedure is carried out using a machine called a Blood Cell Separator, which separates blood into its different components. Your blood is drawn through a needle placed in one arm and passes through the machine, where the plasma is removed. Replacement plasma is then added before the blood is returned to you through a needle in the other arm.

If your veins are not suitable, a central line (larger HD catheter) in your neck vein may need to be placed. This line will allow the blood to be removed and returned safely during the procedure.

How Should I Prepare for the Procedure?

• Medications: Some medications may need to be adjusted before the procedure. Inform your doctor of any medicines you are taking so that you are advised on whether to take them as usual or delay a dose.
• Food and Drink: It is important to eat and drink before the procedure to keep your body hydrated.
• If you have fever or feel or unwell, please inform your treating doctor before proceeding the procedure, as the procedure might need to be delayed.

During the procedure

• A hospital staff will be with you throughout the procedure to ensure you're comfortable and safe. You'll rest in a bed, and the process will take about 2-3 hours, depending on the amount of plasma that needs to be exchanged.

After the Procedure

• You will be under observation for at least 2 hours after completion of procedure and avoid strenuous activity for the rest of the day.
• You will be monitored for possible transfusion reactions or any allergic reactions due to replacement fluids.
• Continue all medications as per schedule unless advised otherwise.
• Maintain hydration and nutrition as advised.

Side Effects and Sensations during the Procedure

The most common risks include:

• Infection: There is a very small chance of infection from the intravenous line
• Bleeding: There is a slight risk of bleeding after the line is removed because of a blood thinner having been added to your blood. To minimize this risk, you will be asked to remain resting in bed for at least 10 minutes with pressure dressings applied after the needles are taken out.
• Allergy: When donor plasma (FFP) is used as a replacement fluid, there is a small chance of allergic reactions such as itching, rashes or hives. These are usually mild and resolve with medication.
• You might also experience:
  • Dizziness due to low blood pressure
  • A feeling of coldness
  • Nausea (feeling unwell)
  • Tingling sensations in your face, hands, or feet
  • Allergic reactions like itching and rashes.
  • A metallic taste in your mouth
  • A heavy sensation in your arm or vibration at the needle site

These effects are usually mild and go away once the procedure is finished. Let the nurse know if any symptoms are causing you distress, as they can usually be easily managed.You may also receive blood or plasma transfusions during the procedure. While these are generally well-matched to your blood group, mild reactions can happen, so it's important to notify staff if you feel unwell, especially when the new blood or plasma is introduced.

How Many Plasma Exchanges Will I Need?

The number of plasma exchanges you'll require depends on the nature and severity of your liver disease, as well as how well you respond to treatment.

Aftercare and Follow-Up

Plasma exchange will help manage your symptoms, but it is usually part of a broader treatment plan for liver disease. You will likely need continued care and monitoring, including regular follow-up visits.