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Plasmapheresis or — plasma exchange — is a process involving the following steps:

  1. Whole blood is withdrawn from the person.
  2. The liquid portion or plasma is removed from the blood and replaced.
  3. The blood, with all its red and white blood cells, is transfused back into the person.

This blood-cleansing procedure is a successful method for treating some autoimmune diseases — such as myasthenia gravis and Guillain-Barré syndrome — because it removes the circulating antibodies that are thought to be active in these diseases. Side effects of plasmapheresis therapy include occasional infection and blood clotting problems.

Because multiple sclerosis (MS) may also involve an autoimmune process — where the body is attacked by its own immune system — and because damaging factors have been found in plasma from people with MS, plasmapheresis has been tried as a treatment for MS.

AAN guidelines for use

Irene Cortese, MD, and colleagues from the Therapeutics and Technology Assessment Subcommittee of the Academy of Neurology (AAN), reviewed the medical literature from 1995 through 2009 to reassess the role of this strategy for treating neurologic disorders, and revised the previous set of AAN guidelines to include recommendations for MS. The new guidelines appear in Neurology (2011;76(3):294-300.

The guidelines recommend that clinicians consider using plasma exchange for a number of conditions for which it has been shown to be beneficial. In people with relapsing forms of MS, the guidelines suggest it may be effective as a secondary therapy for exacerbations that have not responded to treatment with corticosteroids. The guidelines say that plasma exchange may also be useful for severe, rapidly progressive MS and similar disorders (acute fulminant demyelinating CNS disease). The treatment was not found to be effective for secondary-progressive MS or primary-progressive MS.

The vast majority of people experiencing acute attacks respond well to the standard high-dose corticosteroid treatment. According to the guidelines, plasma exchange should be considered a treatment alternative only for the few who do not, and only for a short time.