What are the steps involved in performing plasmapheresis?

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

The following is an example of the steps involved in performing therapeutic plasma exchange using centrifugation-based equipment such as the Spectra Auto PBSC:

  • Any heparin that may be present in each of the two lumens of a central venous catheter is removed
  • A waste of 3 mL is then discarded
  • Laboratory studies, including complete blood count (CBC), calcium, and fibrinogen, are ordered and specimens sent from the draw lumen
  • A flush with 10 mL of normal saline is placed in the draw lumen
  • The draw and return lumens are then connected to the tubing, which is previously primed with normal saline; however, if a patient weighs less than 20 kg, then the draw and return tubing is primed with packed red blood cells (RBCs) instead of normal saline
  • Height and weight are then entered into the system to allow estimation of total blood volume (TBV)
  • Plasma volume is then calculated as follows: TBV × (1 – hematocrit)
  • A replacement product is chosen
  • The total volume of the desired replacement product is entered—usually either 1 plasma volume (40 mL/kg) or 1.5 plasma volume (60 mL/kg)
  • A centrifuge speed is determined by the software on the basis of the data entered
  • The device then draws whole blood through the draw lumen to the centrifuge
  • Plasma is separated by the centrifuge and collected for discard
  • RBCs are also separated by the centrifuge, then returned to the patient along with the previously selected colloid of either albumin or fresh frozen plasma (FFP)
  • After the desired amount of plasma is removed, the machine is disconnected from the patient, and heparin is instilled into each catheter lumen to prevent clotting until the lumen is accessed again
  • A post–plasma exchange fibrinogen level is checked if albumin was used as the replacement product (albumin does not contain fibrinogen, as opposed to FFP) to assess whether the patient has become severely hypofibrinogenemic

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