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Plasma Exchange

Plasma Exchange consists of the removal of large volumes of the patient' s plasma and replacing it with exogenous plasma or plasma substitutes Action: removes from the circulation any pathogenic material decrease T lymphocytes (indirect action) normalize abnormal T4/T8 ratio (indirect).

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Plasma Exchange

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  1. Plasma Exchange • consists of the removal of large volumes of the patient' s plasma and replacing it with exogenous plasma or plasma substitutes • Action: • removes from the circulation any pathogenic material • decrease T lymphocytes (indirect action) • normalize abnormal T4/T8 ratio (indirect)

  2. In 10 Pxs with PG treated with plasma exchange once to three times weekly for a total of 4 to 27 exchanges - (7) excellent response - (3) incomplete or no response

  3. Potential complications include: • vasovagal reactions • hypovolemia or fluid • overload, • electrolyte abnormalities • infection of indwelling lines, • bleeding tendency caused by depletion of platelets or clotting factors, • InPx given plasma as replacement fluid: • allergic reactions • transfusion-related infections (hepatitis, HIV) • difficulty in gaining vascular access, • lesions can develop at venipuncture sites.

  4. Human intravenous immune globulin (IVIG) Therapy • human IVIG, 0.4 gm/kg per day, for 5 days • effective in one patient with PGP after failure to respond to prednisone, dapsone, cyclosporine,and pulse methylprednisolonewhile therapy with cyclosporine and prednisone was continued. * When used at the higher doses, IVIG possesses immunosuppressive activity through poorly understood mechanisms.

  5. The principal disadvantages of this treatment • high cost • adverse effects(headache, chills, fever) • potential for transmissionof diseases with pooled sera.

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