From the Research
Plasmapheresis (plasma exchange or PLEX) is a valuable adjunctive therapy in autoimmune hemolytic anemia (AIHA), particularly in severe or refractory cases, as evidenced by a recent study published in 2021 1.
Key Points
- PLEX is most beneficial in warm AIHA cases with high antibody titers and in cold agglutinin disease during acute hemolytic crises.
- The typical regimen involves 5-7 treatments performed every other day, exchanging 1-1.5 plasma volumes per session.
- PLEX works by rapidly removing autoantibodies, immune complexes, and complement components from circulation, providing temporary relief while other immunosuppressive therapies take effect.
- For optimal results, PLEX should be combined with corticosteroids (prednisone 1-2 mg/kg/day) and/or rituximab (375 mg/m² weekly for 4 weeks), as recommended by recent guidelines 2.
Considerations
- PLEX should not be used as monotherapy since antibody production continues unabated, leading to rebound hemolysis once treatments stop.
- The procedure carries risks including bleeding, hypocalcemia, and infection, so patients should be monitored for these complications.
- While not curative, PLEX can be life-saving in severe cases with dangerously low hemoglobin levels or when patients are unresponsive to first-line treatments, as reported in a case study published in 2021 1.
Evidence
- A study published in 2021 1 reported the successful use of PLEX in a patient with severe IgG subtype hemolytic anemia who was unresponsive to immunosuppressive treatments.
- Another study published in 2014 3 discussed the use of PLEX as a last resort option in severe or refractory AIHA cases.
- Recent guidelines published in 2020 2 recommend the use of PLEX as an adjunctive therapy in AIHA, particularly in severe or refractory cases.