From the Guidelines
Plasmapheresis can cause several side effects that require careful management, including hypotension, citrate toxicity, allergic reactions, and bleeding risk, which can be mitigated with proper monitoring and treatment. The management of these side effects is crucial to prevent morbidity and mortality. According to the most recent evidence 1, plasma exchange can be associated with hemodynamic shifts, coagulation disorders, electrolyte imbalances, and line-related bacteremia, requiring a careful risk-benefit analysis.
Some of the common side effects of plasmapheresis include:
- Hypotension, which can be managed by slowing the procedure rate, administering IV fluids, and positioning the patient in Trendelenburg
- Citrate toxicity, which can be treated with oral or IV calcium supplementation
- Allergic reactions, which require stopping the procedure and administering antihistamines, steroids, or epinephrine as needed
- Bleeding risk, which can be mitigated by monitoring coagulation parameters and administering fresh frozen plasma when necessary, although the use of fresh frozen plasma is not recommended for correction of a prolonged INR in patients with cirrhosis undergoing invasive procedures 1
- Electrolyte imbalances, particularly hypokalemia and hypomagnesemia, which require regular monitoring and replacement
- Hypogammaglobulinemia, which may develop with repeated treatments, potentially necessitating immunoglobulin replacement therapy
It is essential to monitor patients throughout the procedure with vital sign checks every 15-30 minutes and consider prophylactic acetaminophen or diphenhydramine to reduce reaction risk. The removal of important plasma proteins, such as clotting factors, can result in coagulation defects, and the use of plasma exchange should be carefully considered, especially in patients with underlying coagulopathy 1.
From the Research
Plasmapheresis Side Effects
- The most common side effects of plasmapheresis include a fall in arterial blood pressure (8.4% of all procedures), arrhythmias (3.5%), sensations of cold with temporarily elevated temperature and paresthesias (1.1% each) 2.
- Severe and life-threatening episodes, such as shock, fall in arterial blood pressure requiring pressor amines, persistent arrhythmias, and haemolysis, developed in 2.16% of procedures 2.
- Other potential side effects of plasmapheresis include disturbances of the acid-base equilibrium or the coagulation, and allergic reactions 3.
- Citrate reactions, haemolysis, infiltration, and air embolism are also possible complications of plasmapheresis 4.
Management of Plasmapheresis Side Effects
- Continuous observation and proper monitoring of patients provided by highly trained medical personnel are essential for the safe management of plasmapheresis side effects 2.
- Most complications of plasmapheresis can be avoided with proper technique and monitoring 3.
- Conservative procedural controls and donor harm minimization policies can help mitigate the risk of plasmapheresis side effects 4.
- The use of selective plasmapheresis, which removes specific pathogenic macromolecules, may help reduce the risk of side effects compared to non-selective plasmapheresis 3.
Prevention of Plasmapheresis Side Effects
- Proper patient selection and screening can help prevent plasmapheresis side effects 3.
- The use of high-quality equipment and supplies can also help reduce the risk of complications 4.
- Regular maintenance and testing of plasmapheresis equipment can help prevent technical problems and reduce the risk of side effects 4.
- Donor safety protocols, such as monitoring for citrate reactions and haemolysis, can help prevent complications in donors undergoing plasmapheresis 4.