What are the contraindications for plasmapheresis?

Updated: Mar 08, 2021
  • Author: Elliot Stieglitz, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Plasmapheresis is contraindicated in the following patients:

  • Patients who cannot tolerate central line placement
  • Patients who are in an actively septic state or are hemodynamically unstable - Although plasmapheresis can remove various mediators from the blood and so, in theory, would appear to be potentially useful in treating sepsis, patients in a septic state are often coagulopathic and hemodynamically unstable, which poses significant risks when catheters are inserted and connected to a mechanical circuit; there are some ongoing trials evaluating plasmapheresis in sepsis, but at present, there are no clear data to suggest that the clinical benefits of using plasmapheresis in this setting outweigh the risks associated with its use
  • Patients who have allergies to fresh frozen plasma (FFP) or albumin, depending on the type of plasma exchange
  • Patients with heparin allergies should not receive heparin as an anticoagulant during plasmapheresis
  • Patients with hypocalcemia are at risk for worsening of their condition because citrate is commonly used to prevent clotting and can potentiate hypocalcemia
  • Patients taking angiotensin-converting enzyme (ACE) inhibitors are advised to stop taking the medication for at least 24 hours before starting plasmapheresis

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