Plasmapheresis is a medical procedure that helps manage certain conditions by removing specific substances from the blood. It involves taking blood from a person, separating the liquid portion known as plasma from the blood cells, and then treating or replacing that plasma. This process is typically used to remove harmful antibodies or other problematic proteins circulating in the plasma that contribute to various autoimmune or neurological disorders.
Immediate and Common Reactions
During or immediately after plasmapheresis, some individuals may experience common and generally mild reactions. Hypotension, or low blood pressure, can occur because removing plasma temporarily reduces the body’s blood volume, leading to symptoms such as dizziness, lightheadedness, or blurred vision. This reaction affects a small percentage of patients, typically ranging from 1% to 6%.
Another common reaction involves citrate, an anticoagulant added to the blood to prevent clotting within the machine’s tubing. Citrate can temporarily bind to calcium in the bloodstream, leading to a temporary drop in calcium levels, known as hypocalcemia. This can manifest as tingling sensations around the mouth, in the fingers, or toes, muscle cramps, or occasionally a metallic taste in the mouth.
Individuals often report feeling fatigued or tired after a plasmapheresis session, with about 36% of patients experiencing this sensation. Additionally, some may feel cold during the procedure because the replacement fluids or the returned blood cells are slightly cooler than body temperature. Medical teams are prepared to provide blankets or warm fluids to ensure comfort and manage these common, transient effects.
Catheter and Access Site Complications
The entry point for plasmapheresis, whether a peripheral vein or a central venous catheter, can sometimes lead to localized complications. Following the procedure, it is common to observe some bleeding or bruising at the needle insertion site. Localized pain at the access site is also possible, a temporary discomfort from the needle or catheter placement.
A more concerning, though less frequent, complication is the risk of infection at the catheter site, especially when a central line is used for prolonged access. Healthcare providers emphasize keeping the area clean and dry to minimize this risk. Patients are advised to watch for signs such as increased redness, swelling, warmth, or discharge around the site, as these could indicate an infection.
Beyond surface issues, deeper complications related to vascular access can occur, though rarely. These might include phlebitis, an inflammation of the vein, or the formation of a blood clot within the accessed vein. In extremely rare instances, particularly with central line placement in the chest, a pneumothorax, which is air leaking into the space between the lung and chest wall, can happen.
Significant but Less Frequent Complications
While plasmapheresis is generally considered safe, some more serious complications can occur, though they are uncommon. Allergic reactions to the replacement fluids, such as albumin or fresh frozen plasma (FFP), are possible. Symptoms can range from mild skin reactions like hives and itching to more severe responses, including difficulty breathing or a full anaphylactoid reaction. FFP has been associated with higher rates of adverse reactions compared to albumin.
Maintaining a delicate balance in blood clotting is another consideration. The anticoagulants used during the procedure, while necessary to prevent clots in the machine, can rarely lead to an increased risk of bleeding. Conversely, in some infrequent cases, blood clots can form in the vessels despite anticoagulation.
A very rare but serious complication associated with any extracorporeal circuit, where blood is circulated outside the body, is an air embolism. This occurs if air enters the bloodstream through the tubing, which can be dangerous. Modern plasmapheresis machines incorporate safety features and trained medical staff continuously monitor for such occurrences, allowing for immediate intervention.
Managing and Preparing for Side Effects
Staying well-hydrated by drinking plenty of non-caffeinated fluids before the session is often recommended, as this can help reduce the risk of low blood pressure. Eating a nutritious meal and getting adequate sleep the night before treatment also supports the body’s readiness for the procedure.
During the plasmapheresis session, the medical team plays a primary role in managing potential side effects. They continuously monitor the patient’s vital signs, typically every 15 to 30 minutes, to detect any changes promptly. If citrate-related symptoms arise, calcium supplements can be administered, often intravenously, to correct the temporary calcium imbalance.
The team can also adjust the machine’s speed or administer warmed fluids to address discomforts like feeling cold or sudden drops in blood pressure. After the procedure, patients may be advised to apply pressure if minor bleeding occurs at the access site or use cold and then warm compresses for bruising. Arranging for someone to drive home is also a practical step, as fatigue can persist for a few hours.