Therapeutic Membrane Plasmapheresis
What are the Risks Associated with Plasmapheresis?
Adverse reactions due to plasmapheresis occur in an estimated 7 percent of all procedures performed, and about 40% of patients will experience complications of one form or another. However, it is important to note that complications that are considered severe occur in less that one percent of all procedures, and the vast majority of adverse reactions experienced by patients are minor. Hypotension, or a drop in blood pressure, is the most common of these, and can manifest as chills, faintness, dizziness, or blurred vision. Also, as anticoagulation is required during plasmapheresis, citrate anticoagulants can sometimes cause citrate toxicity. Symptoms of mild citrate toxicity include nausea and vomiting, and very mild toxicity can even be asymptomatic. Usually, the health care staff can control citrate toxicity by decreasing the anticoagulant flow rate, which would decrease the amount of citrates added to the body.
As stated above, severe complications are very rare. Infection of the venous access site is the most common severe adverse reaction, occurring in 0.5% of procedures. Most of these infections are not life-threatening and can be treated with intravenous antibiotics. Transmission of hepatitis or HIV is certainly a logical concern, but the occurrence of transmission is extremely rare.
On the left: the HIV virus. On the right: the Hepatitis B virus.
In one study, no cases of hepatitis or HIV transmission occurred in 1283 procedures performed over the course of four years. Excess removal of coagulation and anti-thrombotic factors in the blood during the plasampheresis procedure can very rarely lead to hemorrhagic and thrombotic (blood clotting) complications. In the same study, no incidences of hemorrhage or thrombosis occurred in the study group (the authors note that this is probably because they remained below the maximum recommended annual pheresis volume).
A blood clot
It is difficult to determine the mortality rate of plasmapheresis, but most scientists estimate the incidence of fatality at about three deaths in 10,000 procedures. Since patients will almost certainly undergo fewer than 10,000 plasmapheresis treatments in their lifetimes (probably far, far fewer), the likelihood of death is miniscule.
Plasmapheresis is a safe procedure when performed by an experience health care staff. Most complications are minor and not life-threatening. However, patients still should immediately inform a doctor or nurse if they experience any irregular or adverse symptoms.
Sources:
Vucic S, Davies L. Safety of Plasmapheresis in the Treatment of Neurological Disease. Aust NZ J Med 1998; 28.Shemin D, Briggs D, Greenan M. Complications of Therapeutic Plasma Exchange: A Prospective Study of 1,727 Procedures. Journal of Clinical Apheresis 2007; 22.
Huestis, Douglas W. Risks and Adverse Reactions Associated with Hemapheresis. Therapeutic Hemapheresis Volume I. CRC Press, Inc. Boca Raton, 1985.
Blust, Jeanne E and Parrish, Judith. Therapeutic Pheresis: Precautions and Nursing Intervention. Therapeutic Hemapheresis Volume I. CRC Press, Inc. Boca Raton, 1985.
Image Sources:
http://www.international.ucla.edu/cms/images/hiv_virus.jpg
Bio 1080 (Organ Replacement) - Spring 2008
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