36514 Therapeutic apheresis; for plasma pheresis

Name of the Procedure:

• Common name: Plasma Exchange
• Technical term: Therapeutic Apheresis; Plasmapheresis

Summary

Plasmapheresis is a medical procedure in which the plasma part of the blood is separated from the blood cells and replaced with a substitute solution or donated plasma. This process helps remove harmful substances from the plasma.

Purpose

• Medical Condition or Problem Addressed: Plasmapheresis is used to treat various autoimmune disorders, blood disorders, and certain neurological conditions.
• Goals or Expected Outcomes: The primary goal is to remove disease-causing antibodies or toxins, thereby reducing symptoms and slowing disease progression.

Indications

• Specific Conditions: Guillain-Barré syndrome, myasthenia gravis, thrombotic thrombocytopenic purpura (TTP), and multiple sclerosis relapses.
• Patient Criteria: Patients with severe symptoms unresponsive to standard treatments, and those for whom rapid symptom relief is necessary.

Preparation

• Pre-procedure Instructions: Patients may need to fast for a few hours before the procedure. They should also inform their healthcare provider of any medications they are taking.
• Diagnostic Tests: Blood tests to assess overall health and clotting status.

Procedure Description

1. Initial Setup: The patient lies on a bed or reclining chair.
2. Venous Access: A needle or catheter is inserted into a vein, usually in the arm.
3. Blood Withdrawal: Blood is drawn from the body and passed through a machine.
4. Plasma Separation: The machine separates plasma from the blood cells.
5. Plasma Replacement: The separated plasma is discarded and replaced with donor plasma or a plasma substitute.
6. Blood Return: The reconstituted blood is returned to the patient's body.
   • Tools and Equipment: Apheresis machine, catheters or needles, replacement plasma.
   • Anesthesia/Sedation: Typically, no anesthesia is required, but local anesthetic may be used for needle insertion.

Duration

The procedure usually takes about 2-4 hours.

Setting

Plasmapheresis is typically performed in a hospital or outpatient clinic.

Personnel

• Healthcare Professionals: Trained nurses, apheresis technicians, and occasionally a supervising physician.

Risks and Complications

• Common Risks: Low blood pressure, dizziness, nausea, and temporary numbness or tingling.
• Rare Risks: Allergic reactions, bleeding, and infection at the needle site.
• Management: Monitoring and immediate treatment of any adverse reactions.

Benefits

• Expected Benefits: Reduction in symptoms and halting of disease progression.
• Timeline: Benefits may be realized immediately or within a few days after the procedure.

Recovery

• Post-procedure Care: Patients are monitored for a short period before being allowed to go home.
• Recovery Time: Most patients can resume normal activities within a day, depending on the underlying condition.
• Restrictions and Follow-up: Follow-up appointments are usually scheduled to monitor the patient's response and adjust treatment if necessary.

Alternatives

• Other Treatment Options: Medications like immunosuppressants or steroids.
• Pros and Cons: Medications may take longer to achieve desired effects and can have different side effects, while plasmapheresis offers quicker symptom relief.

Patient Experience

• During the Procedure: Patients may feel a mild discomfort from needles and temporary sensations like dizziness or numbness.
• After the Procedure: Most patients report feeling tired but are generally able to resume normal activities within a short period. Pain management typically involves over-the-counter pain relievers and ensuring adequate hydration.