Jesse2233
Senior Member
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Summary: A procedure that filters blood and replaces plasma could bring immediate short term benefit on a regular basis, and help patients determine if their disease has an autoimmune component.
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Plasmapheresis (in permutations of immunoadsorption, plasma exchange / PLEX, and apheresis) has been discussed sporadically here (usually in regards to Dr Carmen Scheibenbogen's ongoing research at the Charite in Germany).
As far as I can tell only @Freddy, @BiancaS, @Shawn and @charles shepherd have tried plasmapheresis, and only on a limited basis. I believe @Shawn and @Freddy noted transitory benefit.
It's been said that because plasmapheresis filters out antibodies and replaces them with healthy donor plasma, it could be a quick way to assess autoimmunity based on symptomatic improvement. You would be able to test for autoimmunity in cases with unknown or rare autoantibodies lacking readily available blood tests.
If a patient knew that autoimmunity was the core cause of their disease, then they could more confidently pursue potentially risky treatment modalities like immunosuppression (i.e. Rituximab or Cyclophosphamide).
A nice thing about it is that unlike most treatments, its effects are usually immediate. In other words, if you were a responder, you would feel better right away.
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Plasmapheresis seems to be dismissed out of hand because it's expensive, invasive, produces temporary benefits, and many hospitals are reluctant to use it. Let's tackle each of these one by one.
Even with the caveats listed above, I'm surprised plasmapheresis isn't discussed and used more often by patients, doctors, hospitals, and researchers.
I'm by no means an expert, and there are likely things I'm overlooking, so take what I say as a starting point for discussion and as a not definitive statement.
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Plasmapheresis (in permutations of immunoadsorption, plasma exchange / PLEX, and apheresis) has been discussed sporadically here (usually in regards to Dr Carmen Scheibenbogen's ongoing research at the Charite in Germany).
As far as I can tell only @Freddy, @BiancaS, @Shawn and @charles shepherd have tried plasmapheresis, and only on a limited basis. I believe @Shawn and @Freddy noted transitory benefit.
It's been said that because plasmapheresis filters out antibodies and replaces them with healthy donor plasma, it could be a quick way to assess autoimmunity based on symptomatic improvement. You would be able to test for autoimmunity in cases with unknown or rare autoantibodies lacking readily available blood tests.
If a patient knew that autoimmunity was the core cause of their disease, then they could more confidently pursue potentially risky treatment modalities like immunosuppression (i.e. Rituximab or Cyclophosphamide).
A nice thing about it is that unlike most treatments, its effects are usually immediate. In other words, if you were a responder, you would feel better right away.
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Plasmapheresis seems to be dismissed out of hand because it's expensive, invasive, produces temporary benefits, and many hospitals are reluctant to use it. Let's tackle each of these one by one.
- Invasive. It involves removing blood from the body, filtering it to remove plasma, and reintroducing it with donor plasma. My understanding is that it has become much safer than it was in the past, and serious side effects (such as blood loss/clotting and calcium depletion) are rare with an experienced facility.
The most common side effects are temporary reductions in blood pressure, sensations of coldness, and tiredness after the procedure.
It takes 2-3 hours and can be administered via two IV lines or a central catheter and is generally done as an outpatient procedure.
- Expensive. This is true. The cost is between $5-10k per session (1).
However this is in line with the cost of autoimmune dose IVIG, which seems to be much more commonly used even though it has greater side effect potential and a longer time to produce benefit.
If one had deep pockets / a willing hospital, was part of a research study, or found a comorbid condition that had insurance coverage, the expense would be less relevant. A one off treatment might be worth the cost alone to determine autoimmunity and thus indicate less expensive (though more risky) treatments.
- Temporary benefits. Once the body begins reproducing autoantibodies disease symptoms would return. However there are autoimmune diseases such as Myasthenia Gravis that are treated with plasmapheresis on a monthly or biweekly basis. In certain cases this allows patients to lead normal lives. 2-3 hours of outpatient treatment once every 2-4 weeks for a productive life seems like a decent trade-off to me.
Plasmapheresis can also potentiate the effectiveness of longer lasting autoimmune treatments such as IVIG or immunosuppression. For example, it's sometimes used in conjunction with these treatments in cases of Guillain-Barré or Limbic Encephalitis.
- Reluctant hospitals. Because of the expense and traditionally limited range of treatment indications, hospitals appear reluctant to use it, even for those willing to pay.
However there are hospitals in Germany, China, and Mexico that offer greater patient freedom at reduced cost. You of course want to find a reputable one.
Even with the caveats listed above, I'm surprised plasmapheresis isn't discussed and used more often by patients, doctors, hospitals, and researchers.
I'm by no means an expert, and there are likely things I'm overlooking, so take what I say as a starting point for discussion and as a not definitive statement.