Plasma Exchange Protocol

Question 1

Plasma Exchange (PLEX)
- Removal of __ that contains (3)
- Replacement fluid (3) of equivalent volume

Answer 1

Patient’s plasma - toxin, antibodies, abnormal proteins
Replacement fluid - normal saline, albumin, FFP

Question 2

What are the indications for PLEX (non-exhaustive)

Answer 2

A. Neurology
1. GBS (AIDP) and CIDP
2. Myasthenia gravis and Lambert-Eaton MS
3. Multiple sclerosis and demyelianting disorder
4. Autoimmune encephalitis
5. Stiff person syndrome

B. Pre-transplantation
1. ABO incompatibility transplant

C. Liver replacement in acute liver failrue

D. Autoimmune haemolytic anaemia

Question 3

What are the contraindications to PLEX?

Answer 3

1. Hypotension < 100/60
2. Unstable angin / myocardial infarct
3. Severe sepsis
4. Low cardiac output heart failrue
5. Contraindications to anticoagulation - ICH, active bleeding
6. Allergy to acid-citrate-dextrose in fluid replacement

Question 4

What are the complications of PLEX?

Answer 4

1. Citrate toxicity
2. Hypocalcaemia
3. Allergic reaction
4. Hypovolaemia and hypotension
5. Hypervolaemia and overload
6. Vasovagal reaction
7. Plasma protein and clotting factors depletion
8. Immunosuppression