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Therapeutic Plasma Exchange (TPE)

Jo FrowdeHello, I am Jo Frowde, ISN Guide to Therapeutic Plasma Exchange. Therapeutic Plasma Exchange (TPE) is an extracorporeal therapy treatment, which has been used successfully for limited scleroderma. See Disclaimer.

Overview
TPE for Scleroderma
TPE for Other Diseases

Overview

Eagle MountainsTherapeutic plasma exchange (TPE) is a treatment that removes plasma from your blood, which is then replaced with a substitute. Plasma is the liquid portion of blood which helps carry blood cells and other substances throughout your body. Plasma exchange (plasmapheresis) is a way of separating plasma from blood cells.

Plasmapheresis is a term used to refer to a broad range of procedures in which extracorporeal separation of blood components results in a filtered plasma product. Medscape.

Therapeutic Plasma Exchange (TPE) is a procedure where a large volume of blood is extracted in a continuous flow process. The main blood components (red blood cells, white blood cells, and platelets) are separated from the plasma by a centrifugal process, and the extracted cells are re-combined with a plasma replacement such as sterilized albumin. The Scleroderma Education Project, SclerodermaInfo.org

The mechanisms of action of plasma exchange. This treatment has been applied to a wide variety of diseases but limited research has been published examining the mechanisms of action of TPE. PubMed, Br J Haematol.

TPE for Scleroderma

Case Report: Diffuse alveolar haemorrhage in a case with anti-RNA polymerase III antibody-positive systemic sclerosis successfully treated with plasma exchange and corticosteroid therapy. We immediately started the patient on plasma exchange; subsequently, her diffuse alveolar haemorrhage and thrombotic microangiopathy dramatically improved. PubMed, Mod Rheumatol Case Rep, 2020 Jan;4(1):51-55.

Therapeutic efficacy of combined glucocorticoid, intravenous cyclophosphamide, and double-filtration plasmapheresis for skin sclerosis in diffuse systemic sclerosis (dcSSc). This preliminary case series demonstrates the potential of triple therapy for treating dcSSc. PubMed, Medicine (Baltimore), 2020 Mar;99(10):e19301.

Scleroderma renal crisis (SRC) during intravenous cyclophosphamide pulse therapy for complicated interstitial lung disease (ILD) was successfully treated with angiotensin converting enzyme inhibitor and plasma exchange (PE). This study presents the possibility of favorable effects of PE for SSc–associated ILD and SRC. PubMed, Nagoya J Med Sci. (Also see Kidney (Renal) Involvement and Treatments for Pulmonary Fibrosis)

Case Report: 13–year history of scleroderma complicated by renal crisis (SRC) and thrombotic microangiopathy (TMA) treated with plasma exchange (PE). PE should be considered as a treatment option for SRC complicated by TMA. PubMed, Nihon Rinsho Meneki Gakkai Kaishi. (Also see Kidney (Renal) Involvement)

TPE for Other Diseases

Treatment of Vascular Thrombosis in Antiphospholipid Syndrome: An Update. Early use of a combined triple therapy such as anticoagulation, plasma exchange, and steroids with either or not addition of immunoglobulins is important to reduce mortality. PubMed, Hamostaseologie, 2020 Feb;40(1):31-37. (Also see Antiphospholipid Syndrome)

Antigen-specific immunoadsorption of muscle specific kinase (MuSK) autoantibodies as a treatment of MuSK-induced experimental autoimmune myasthenia gravis (MG). Overall, the procedure was efficient, supporting its application for MG treatment. PubMed, J Neuroimmunol, 2020 Feb 15;339:577136. (Also see Myasthenia Gravis)

Therapeutic plasma exchange and double filtration plasmapheresis in severe neuroimmune disorders. The rate of neurological improvement was similar to other studies. PubMed, Acta Clin Croat, 2019 Dec;58(4):621-626.

Improvement of quality of life after therapeutic plasma exchange in patients with myasthenic crisis. Therapeutic plasma exchange significantly improves the quality of life of patients with myasthenia gravis during the crisis. PubMed, Neurol Neurochir Pol. (Also see Myasthenia Gravis)

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