Clinical and Experimental Nephrology

, Volume 18, Issue 1, pp 41–49 | Cite as

Current topics in therapeutic plasmapheresis

  • Takeshi NakanishiEmail author
  • Naoki Suzuki
  • Takahiro Kuragano
  • Yasuyuki Nagasawa
  • Yukiko Hasuike
Review Article


Therapeutic plasmapheresis has been used for intractable diseases that cannot be cured by conventional drug therapy. Currently, the use of therapeutic plasmapheresis has been approved for 27 diseases by Japan’s National Health Insurance system and is mainly categorized into three modalities: plasma exchange (PE), double-filtration plasmapheresis (DFPP), and plasma adsorption (PA). Plasma separators and/or fractionators are essential for the therapy. PE is performed for two purposes: removal of pathogenic antigens or substances in the plasma fraction and supplementation of essential factors, such as albumin and coagulation factors. PE can be used for thrombotic microangiopathy and acute hepatic failure. DFPP can be performed for selective removal of macromolecules while avoiding the use of substitution fluid (i.e., albumin or fresh frozen plasma). DFPP has now been used for conditions involving relatively larger plasma molecules, including hyperviscosity syndrome and ABO-incompatible kidney transplantation. PA can specifically remove pathogenic agents, such as low-density lipoprotein or autoantibodies, in the IgG fractions by the adsorption column and does not require substitution fluids. PA has now been used for a wide variety of neurological diseases, including chronic inflammatory demyelinating polyneuropathy. This review describes the characteristics of each modality, seeking to improve the efficacy and specificity of removal of the target substance.


Therapeutic plasmapheresis Plasma exchange Double filtration plasmapheresis Plasma adsorption 


Conflict of interest

The authors declared no competing interests.


  1. 1.
    Graw RG Jr, Herzig GP, Eisel RJ, Perry S. Leukocyte and platelet collection from normal donors with the continuous flow blood cell separator. Transfusion. 1971;11:94–101.PubMedCrossRefGoogle Scholar
  2. 2.
    Liégeois A, Escourrou J, Ouvré E, Charreire J. Microchimerism: a stable state of low-ratio proliferation of allogeneic bone marrow. Transplant Proc. 1977;9:273–6.PubMedGoogle Scholar
  3. 3.
    Sueoka A. Present status of apheresis technologies: part 1. Membrane plasma separator. Ther Apher. 1997;1:42–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis. 2008;52:1180–96.PubMedCrossRefGoogle Scholar
  5. 5.
    Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Apheresis Applications Committee of the American Society for Apheresis, et al. Guidelines on the use of therapeutic apheresis in clinical practice–evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2010;25:83–177.PubMedCrossRefGoogle Scholar
  6. 6.
    Fuss M, Bagon J, Dupont E, Manderlier T, Brauman H, Corvilain J. Parathyroid hormone and calcium blood levels in acute renal failure. With special reference to one patient developing transient hypercalcemia. Nephron. 1978;20:196–202.PubMedCrossRefGoogle Scholar
  7. 7.
    Brecher ME. Plasma exchange: why we do what we do. J Clin Apher. 2002;17:207–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Balogun RA, Ogunniyi A, Sanford K, Okafor C, Lobo PI, Siami G, Barcia J, Kaplan AA. Therapeutic apheresis in special populations. J Clin Apher. 2010;25:265–74.PubMedCrossRefGoogle Scholar
  9. 9.
    McLeod BC. Therapeutic apheresis: use of human serum albumin, fresh frozen plasma and cryosupernatant plasma in therapeutic plasma exchange. Best Pract Res Clin Haematol. 2006;19:157–67.PubMedCrossRefGoogle Scholar
  10. 10.
    Crookston KP, Simon TL. Physiology of apheresis. In: McLeod BC, editor. Apheresis principles and practice. Bethesda: AABB Press; 2003. p. 71–93.Google Scholar
  11. 11.
    Chopek M, McCullough J. Protein and biochemical changes during plasma exchange. In: Berkman EM, Umlas J, editors. Therapeutic Hemapheresis. Washington, DC: American Association of Blood Banks; 1980. p. 13–52.Google Scholar
  12. 12.
    Weinstein R. Basic priciples pf therapeutic Blood exchange. In: Mcleod BC, Price TH, Weinstein R, editors. Apheresis: principles and practice. 2nd ed. Bethesda: AABB Press; 2003. p. 295–320.Google Scholar
  13. 13.
    Haddad S, Leitman SF, Wesley RA, Cecco S, Yau YY, Starling J, Rehak NN, Bolan CD. Placebo-controlled study of intravenous magnesium supplementation during large-volume leukapheresis in healthy allogeneic donors. Transfusion. 2005;45:934–44.PubMedCrossRefGoogle Scholar
  14. 14.
    Moake JL. Thrombotic microangiopathies. N Engl J Med. 2002;347:589–600.PubMedCrossRefGoogle Scholar
  15. 15.
    Fujimura Y, Matsumoto M. Registry of 919 patients with thrombotic microangiopathies across Japan: database of Nara Medical University during 1998–2008. Intern Med. 2010;49:7–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Bell WR, Braine HG, Ness PM, Kickler TS. Improved survival in thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Clinical experience in 108 patients. N Engl J Med. 1991;325:398–403.PubMedCrossRefGoogle Scholar
  17. 17.
    Rock GA, Shumak KH, Buskard NA, Blanchette VS, Kelton JG, Nair RC, Spasoff RA. Comparison of plasma exchange with plasma infusion in the treatment of thrombotic thrombocytopenic purpura. Canadian Apheresis Study Group. N Engl J Med. 1991;325:393–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Bruce C, McLeod MD. Therapeutic plasma exchange. In: Winters JL, editor. Therapeutic apheresis: a physicians’s handbook. 2nd ed. Bathesda: American Society for Apheresis (ASFA); 2008. p. 69–134.Google Scholar
  19. 19.
    Stravitz RT. Critical management decisions in patients with acute liver failure. Chest. 2008;134:1092–102.PubMedCrossRefGoogle Scholar
  20. 20.
    Clemmesen JO, Kondrup J, Nielsen LB, Larsen FS, Ott P. Effects of high-volume plasmapheresis on ammonia, urea, and amino acids in patients with acute liver failure. Am J Gastroenterol. 2001;96:1217–23.PubMedCrossRefGoogle Scholar
  21. 21.
    De Silvestro G, Marson P, Brandolese R, Pittoni G, Ongaro G. A single institution’s experience (1982–1999) with plasma-exchange therapy in patients with fulminant hepatic failure. Int J Artif Organs. 2000;23:454–61.PubMedGoogle Scholar
  22. 22.
    Singer AL, Olthoff KM, Kim H, Rand E, Zamir G, Shaked A. Role of plasmapheresis in the management of acute hepatic failure in children. Ann Surg. 2001;234:418–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Agishi T, Kaneko I, Hasuo Y, Hayasaka Y, Sanaka T, Ota K, et al. Double filtration plasmapheresis. Trans Am Soc Artif Intern Organs. 1980;26:406–11.PubMedGoogle Scholar
  24. 24.
    Mineshima M, Akiba T. Double filtration plasmapheresis in critical care. Ther Apher. 2002;6:180–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Sueoka A. Present status of apheresis technologies: part 2. Membrane plasma fractionator. Ther Apher. 1997;1:135–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Ichimaru N, Takahara S. Japan’s experience with living-donor kidney transplantation across ABO barriers. Nat Clin Pract Nephrol. 2008;4:682–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Morelli F, Carlier P, Giannini G, De Luigi MC, Dejana AM, Ruzzenenti MR. Hypercholesterolemia and LDL apheresis. Int J Artif Organs. 2005;28:1025–31.PubMedGoogle Scholar
  28. 28.
    Klingel R, Mausfeld P, Fassbender C, Goehlen B. Lipidfiltration–safe and effective methodology to perform lipid-apheresis. Transfus Apher Sci. 2004;30:245–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Batocchi AP, Evoli A, Di Schino C, Tonali P. Therapeutic apheresis in myasthenia gravis. Ther Apher. 2000;4:275–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Inoue N, Kunishige M, Yoshida S, Oshima Y, Ohnishi Y, Kuroda Y, et al. Dissociation between titer of anti-ganglioside antibody and severity of symptoms in a case of Guillain-Barré syndrome with treatment-related fluctuation. J Neurol Sci. 2003;210:105–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Shimmura H, Tanabe K, Ishikawa N, Tokumoto T, Takahashi K, Toma H. Role of anti-A/B antibody titers in results of ABO-incompatible kidney transplantation. Transplantation. 2000;70:1331–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Shimmura H, Tanabe K, Ishida H, Tokumoto T, Ishikawa N, Miyamoto N, et al. Lack of correlation between results of ABO-incompatible living kidney transplantation and anti-ABO blood type antibody titers under our current immunosuppression. Transplantation. 2005;80:985–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Hirata N, Kuriyama T, Yamawaki N. Immusorba TR and PH. Ther Apher Dial. 2003;7:85–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Asahi T, Yamamoto T, Kutsuki H. Blood purification therapies using dextran sulfate cellulose columns Liposorber and Selesorb. Ther Apher Dial. 2003;7:73–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Krieter DH, Steinke J, Kerkhoff M, Fink E, Lemke HD, Zingler C, Müller GA, Schuff-Werner P. Contact activation in low-density lipoprotein apheresis systems. Artif Organs. 2005;29:47–52.PubMedCrossRefGoogle Scholar
  36. 36.
    Owen HG, Brecher ME. Atypical reactions associated with use of angiotensin-converting enzyme inhibitors and apheresis. Transfusion. 1994;34:891–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Kojima S, Harada-Shiba M, Yamamoto A. Plasma constituents other than low-density lipoprotein adsorbed by dextran-sulfate column. Ther Apher. 1997;1:309–13.PubMedCrossRefGoogle Scholar
  38. 38.
    Jiménez-Klingberg C, Borberg H. Comparison of protein A- and tryptophan-conjugated polyvinyl alcohol gel columns with an anti-human immunoglobulin antibody adsorber. Current advances in therapeutic plasmapheresis. London: Churchill Livingstone; 1996. p. 83–93.Google Scholar
  39. 39.
    Rødgaard A, Nielsen FC, Djurup R, Somnier F, Gammeltoft S. Acetylcholine receptor antibody in myasthenia gravis: predominance of IgG subclasses 1 and 3. Clin Exp Immunol. 1987;67:82–8.PubMedCentralPubMedGoogle Scholar
  40. 40.
    McConville J, Farrugia ME, Beeson D, Kishore U, Metcalfe R, Newsom-Davis J, Vincent A. Detection and characterization of MuSK antibodies in seronegative myasthenia gravis. Ann Neurol. 2004;55:580–4.PubMedCrossRefGoogle Scholar
  41. 41.
    Yamazaki Z, Fujimori Y, Takahama T, Inoue N, Wada T, Kazama M, Morioka M, Abe T, Yamawaki N, Inagaki K. Efficiency and biocompatibility of a new immunosorbent. Trans Am Soc Artif Intern Organs. 1982;28:318–23.PubMedGoogle Scholar
  42. 42.
    Tsuboi Y, Takahashi M, Ishikawa Y, Okada H, Yamada T. Elevated bradykinin and decreased carboxypeptidase R as a cause of hypotension during tryptophan column immunoabsorption therapy. Ther Apher. 1998;2:297–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Gwathmey K, Balogun RA, Burns T. Neurologic indications for therapeutic plasma exchange: an update. J Clin Apher. 2011;26:261–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Lehmann HC, Hartung HP, Hetzel GR, Stüve O, Kieseier BC. Plasma exchange in neuroimmunological disorders: part 2. Treatment of neuromuscular disorders. Arch Neurol. 2006;63:1066–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Hahn AF, Bolton CF, Pillay N, Chalk C, Benstead T, Bril V, Shumak K, Vandervoort MK, Feasby TE. Plasma-exchange therapy in chronic inflammatory demyelinating polyneuropathy. A double-blind, sham-controlled, cross-over study. Brain. 1996;119:1055–66.PubMedCrossRefGoogle Scholar
  46. 46.
    Dyck PJ, Daube J, O’Brien P, Pineda A, Low PA, Windebank AJ, Swanson C. Plasmaexchange in chronic inflammatory demyelinating polyradiculoneuropathy. N Engl J Med. 1986;314:461–5.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2013

Authors and Affiliations

  • Takeshi Nakanishi
    • 1
    Email author
  • Naoki Suzuki
    • 1
  • Takahiro Kuragano
    • 1
  • Yasuyuki Nagasawa
    • 1
  • Yukiko Hasuike
    • 1
  1. 1.Division of Kidney and Dialysis, Department of Internal MedicineHyogo College of MedicineNishinomiyaJapan

Personalised recommendations