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image of neurons close up

Therapeutic Plasma Exchange for Neurology

Explore the immunomodulatory effects of therapeutic plasma exchange (TPE) for neurology and how it works

FOR HEALTHCARE PROFESSIONALS

How it works: Immunomodulatory effects of therapeutic plasma exchange (TPE)

Plasma exchange is an established immunomodulatory therapy that rapidly reduces disease mediators and circulating immune complexes (CICs). Improvement following plasma exchange can occur within a few days.1,2

Plasma exchange mechanism of action and immunomodulatory effect

Proposed mechanism of action:

How TPE works to produce an effect in the body

  • Removal of antibodies
  • Removal of immune complexes
  • Removal of cytokines and chemokines
  • Replacement of missing plasma components

Immunomodulatory effect:

Effect of TPE enabling homeostasis of the immune system

  • Increased proliferation of B cells and plasma cells, sensitizing them to immunosuppressants
  • Restored Th1:Th2 ratio
  • Enhanced macrophage and monocyte function
  • Change in lymphocyte numbers (increase in T cells, decrease in B cells)
  • Increased regulatory and suppressor T cell activity

Results from one study: Reducing disease mediators and time to recovery

Improvement following plasma exchange can occur within a few days.1,2 The mean maximum reduction after one course* of plasma exchange was:3

IgA 69.1%
IgM 79.1%
IgG 73.4%

(subclasses 1-4)

Plasma exchange on the Spectra Optia™ Apheresis System

Not all plasma exchange is the same. Spectra Optia uses specific gravity to separate blood components. Centrifugation, as compared to membrane-based methods, produces more efficient separation, which can make important differences in the patient experience. 

Because centrifugal therapeutic plasma exchange (cTPE) is more efficient than membrane therapeutic plasma exchange (mTPE), it removes 1.5 to 3 times more plasma per volume of whole blood processed, allowing for shorter procedure times and/or lower whole blood flow rates as desired.4-9

Learn more about cTPE

Video illustration of cTPE**

Spectra Optia uses differences in the specific gravity and sedimentation velocity of blood cells and plasma to separate specific blood components. With continuous flow centrifugation, blood is continuously added into the centrifuge; blood cells are separated from plasma, mixed with replacement fluid, and returned to the patient.

Additional features and benefits of the Spectra Optia system

  • Automatically monitors the fluids used in the procedure, which allows for the maintenance of fluid balance
  • Can be performed on an inpatient or outpatient basis
  • Has a median procedure time of 1 hour and 45 minutes (based on analyzed data of more than 40,000 procedures)
  • Accommodates smaller patients and supports patient comfort and safety
  • Allows peripheral venous access with single- or dual-needle options (other venous access options are available)†
Learn more about Spectra Optia

Did you know? Peripheral access data

Data from several studies indicate that 64.3%10 to 94.6%11 of apheresis procedures can be performed using peripheral access.12 (However, in some patients, peripheral access may not be feasible.13-14)

Terminology: Plasma exchange, therapeutic plasma exchange, or plasmapheresis?

These terms are often mistakenly used interchangeably. Here are their distinctions:15

Plasmapheresis refers only to the removal of plasma.

Plasma exchange (PLEX) and therapeutic plasma exchange (TPE) refer to both the removal and the replacement of plasma.

Learn more about therapeutic plasma exchange and patient safety

Learn more

Contraindications
Contraindications for the use of Spectra Optia are limited to those associated with the infusion of solutions and replacement fluids as required by the apheresis procedure and those associated with all types of automated apheresis systems.

Adverse events of apheresis procedures can include
Anxiety, headache, light-headedness, digital and/or facial paresthesia, fever, chills, hematoma, hyperventilation, nausea and vomiting, syncope (fainting), urticaria, hypotension, allergic reactions, infection, hemolysis, thrombosis in patient and device, hypocalcemia, hypokalemia, thrombocytopenia, hypoalbuminemia, anemia, coagulopathy, fatigue, hypomagnesemia, hypogammaglobulinemia, adverse tissue reaction, device failure/disposable set failure, air embolism, blood loss/anemia, electrical shock, fluid imbalance, and inadequate separation of blood components.

Reactions to blood products transfused during procedures can include
Hemolytic transfusion reaction, immune-mediated platelet destruction, fever, allergic reactions, anaphylaxis, transfusion-related acute lung injury (TRALI), alloimmunization, posttransfusion purpura (PTP), transfusion-associated graft-versus-host disease (TA-GVHD), circulatory overload, hypothermia, metabolic complications, and transmission of infectious diseases and bacteria.16-17

Restricted to prescription use only

  • Operators must be familiar with the system's operating instructions.
  • Procedures must be performed by qualified medical personnel.

The Spectra Optia Apheresis System, a blood component separator, may be used to perform the following therapeutic apheresis, cell collection, and cell processing procedures: Therapeutic plasma exchange; red blood cell exchange, depletion, and depletion/exchange for the transfusion management of sickle cell disease in adults and children; mononuclear cell collection from the peripheral blood; granulocyte collection from the peripheral blood; white blood cell reduction for patients with leukocytosis at risk for leukostasis; and processing of harvested bone marrow for the purpose of facilitating hematopoietic reconstitution.

Disclaimers and notes

*Patients underwent a median of 6 (range 5-27) TPE procedures during the trial.

**This graphic is intended to be a high-level representation of an apheresis procedure and therefore does not cover all steps. For a detailed description please contact Terumo Blood and Cell Technologies.

†Single-needle access is not available in all regions.

  1. Saperstein D, Barohn R. Management of myasthenia gravis. Semin Neurology. 2004;24(1):41-48.
  2. Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the writing committee of the American Society for Apheresis: the seventh special issue. J Clin Apher. 2016;31(3):149-162.
  3. Guptill JT, Juel VC, Massey JM, et al. Effect of therapeutic plasma exchange on immunoglobulins in myasthenia gravis. Autoimmunity. 2016;49(7):472-479.
  4. Kes P, Janssens ME, Basic-Jukic N, Kljak M. A randomized crossover study comparing membrane and centrifugal therapeutic plasma exchange procedures. Transfusion. 2016;56(12):3065-3072.
  5. Hafer C, et al. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. Int Urol Nephrol. 2016;48:133-138.
  6. Ward D. Conventional apheresis therapies: a review. Neurology. 1996;47(3):840-843.
  7. Tormey C, et al. Improved plasma removal efficiency for therapeutic plasma exchange using a new apheresis platform. Transfusion. 2010;50(2):471-477.
  8. Cid J, et al. Comparison of plasma exchange procedures using three apheresis systems. Transfusion. 2015;55(5):1001-1007.
  9. Lambert C, et al. Plasma extraction rate and collection efficiency during therapeutic plasma exchange with Spectra Optia in comparison with Haemonetics MCS+. J Clin Apher. 2011;26(1):17-22.
  10. Mortzell Henriksson M, Newman E, Witt V, et al. Adverse events in apheresis: an update of the WAA registry data. Transfus Apher Sci. 2016;54(1):2-15.
  11. Noseworthy JH, Shumak KH, Vandervoort MK. Long-term use of antecubital veins for plasma exchange. Transfusion. 1989;29(7):610-613.
  12. Putensen D, Leverett D, Patel B, Rivera J. Is peripheral access for apheresis procedures underutilized in clinical practice? A single centre experience. J Clin Apher. 2017;32(6):553-559.
  13. Stegmayr B, Wikdahl A. Access in therapeutic apheresis. Ther Apher Dial. 2003;7(2):209-214.
  14. Schonermarck U, Bosch T. Vascular access for apheresis in intensive care patients. Ther Apher Dial. 2003;7(2):215-220.
  15. Assessment of plasmapheresis. Neurology. 1996;47(3):840-843.
  16. AABB. Circular of Information for the Use of Human Blood and Blood Components. Bethesda, MD: AABB; 2017.
  17. European Directorate for the Quality of Medicines & HealthCare (EDQM). Guide to the Preparation, Use and Quality Assurance of Blood Components. 19th edition. Strasbourg, France: EDQM Council of Europe; 2017.
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