What are the complications of plasmapheresis?

Updated: Mar 08, 2021
  • Author: Elliot Stieglitz, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Patients can experience symptoms of hypocalcemia and or hypomagnesemia during and after the procedure and can be treated with replacement calcium and magnesium, respectively. [22]

Patients frequently become hypothermic during the procedure, in which case they should be warmed appropriately.

Patients can experience transfusion-related reactions, in particular with FFP, and should be treated with diphenhydramine, hydrocortisone, and/or epinephrine depending on the severity of the reaction. These reactions can occur during and after the transfusion.

Patients can experience hypotension as a result of rapid fluid shifts, and proper precautions should be taken to minimize complications such as unintended falls.

Patients can become thrombocytopenic and hypofibrinogenemic after plasmapheresis (especially if albumin is being used as a replacement product) and should be monitored for signs of bleeding.

Patients may also be at further risk for developing hypotension if they have a history of taking angiotensin-converting enzyme (ACE) inhibitors, in particular while undergoing column-based plasmapheresis. [23] The suspected mechanism is related to increased bradykinin levels caused by use of ACE inhibitors. This accumulation of kinins leads to hypotension, flushing, and gastrointestinal symptoms. Patients are therefore advised to stop all ACE inhibitors at least 24 hours before starting plasmapheresis.

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