What is Plasmapheresis (PLEX) therapy?

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Last updated: April 4, 2025 • View editorial policy

From the Guidelines

PLEX therapy may be considered as part of therapy to induce remission in GPA or MPA for those with a serum creatinine >300 μmol/L due to active glomerulonephritis, but its routine use to treat alveolar haemorrhage in GPA and MPA is not recommended. The decision to use PLEX therapy should be made on an individual basis, taking into account the potential benefits and risks, including the increased risk of serious infections 1.

Key Considerations

  • PLEX therapy may reduce the risk of end-stage kidney disease (ESKD) at 12 months, particularly in patients with moderate to high-risk kidney disease, but this benefit declines over longer follow-up 1.
  • The use of PLEX therapy is associated with an increased risk of serious infections, which must be weighed against the potential benefits 1.
  • The evidence for the use of PLEX therapy in patients with diffuse alveolar haemorrhage (DAH) is limited, and its use in this context is not recommended without further evaluation 1.

Patient Selection

  • Patients with GPA or MPA and a serum creatinine >300 μmol/L due to active glomerulonephritis may be considered for PLEX therapy 1.
  • Patients with DAH should not be routinely treated with PLEX therapy, but may be considered on a case-by-case basis 1.

Treatment Regimen

  • The treatment regimen for PLEX therapy typically consists of 5-7 treatments over 1-2 weeks, with each session lasting 2-4 hours 1.
  • Patients should be monitored for potential side effects, including hypotension, allergic reactions, bleeding, and electrolyte imbalances 1.

Alternative Therapies

  • Avacopan, in combination with rituximab or cyclophosphamide, may be considered as an alternative to PLEX therapy for induction of remission in GPA or MPA, particularly in patients at risk of glucocorticoid-related adverse effects 1.

From the Research

PLEX Therapy Overview

  • PLEX therapy, also known as plasma exchange, is a treatment option for various medical conditions, including autoimmune hemolytic anemia (AIHA) and myasthenia gravis.
  • The therapy involves the removal of immune complexes, protein-bound toxins, autoantibodies, and high molecular weight solutes and protein-bound solutes from the blood, with the aim of gaining a faster response than immunosuppressive therapy 2, 3.

PLEX Therapy in Autoimmune Hemolytic Anemia

  • Studies have shown that PLEX therapy can be effective in treating AIHA, particularly in cases where patients do not respond to immunosuppressive treatments or require a rapid response 2, 3, 4.
  • The therapy has been shown to decrease transfusion requirements and improve hemoglobin levels in patients with severe AIHA 2, 3, 4.
  • However, the effectiveness of PLEX therapy in AIHA may depend on the type of anemia, with some studies suggesting that it is more beneficial in cold AIHA than in warm AIHA 3.

PLEX Therapy in Other Conditions

  • PLEX therapy has also been used to treat myasthenia gravis, with studies showing that it is safe and effective in patients with moderate to severe disease 5.
  • The therapy has been shown to improve symptoms and reduce the need for other treatments in patients with myasthenia gravis 5.

Safety and Efficacy of PLEX Therapy

  • Studies have reported that PLEX therapy is generally safe and well-tolerated, with most adverse events being mild and easily treated 5, 4.
  • However, the proper role of PLEX therapy in the treatment of AIHA remains uncertain, and more research is needed to fully understand its benefits and limitations 6.

References

Research

Hemolytic anemia and plasma exchange.

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis, 2021

Research

Plasma exchange in autoimmune hemolytic anemia (AIHA).

Journal of clinical apheresis, 1983

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.