Therapeutic Plasmapheresis: A Systematic Review

Sylvester Lazarus, Afreen Fatima, Swati Srivastava, Sharique Ahmad, Mayuri Agarwal, Nida Akhlaq
Author(s)
1Professor, Department of Pathology, American University of Barbados School of Medicine, Wildey, Bridgetown, Barbados. 2Assistant Professor, Department of Pathology, Era’s Lucknow Medical College and Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, Uttar Pradesh, India. 3Associate Professor, Department of Pathology, Era’s Lucknow Medical College and Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, Uttar Pradesh, India. 4Professor, Department of Pathology, Era’s Lucknow Medical College and Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, Uttar Pradesh, India. 5Junior Resident, Department of Pathology, Era’s Lucknow Medical College and Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, Uttar Pradesh, India.

Abstract

Therapeutic plasmapheresis generally referred to as therapeutic plasma exchange (TPE), is an extracorporeal blood purification method which is used to remove pathogenic plasma constituents implicated in a wide range of immune-mediated, hematologic, neurologic, and renal disorders. In contrast to standard dialysis, TPE focus high molecular weight substances such as autoantibodies, immune complexes, paraproteins, and inflammatory mediators. This systematic review analyzes the functional basis, technical considerations, evidence based indications, clinical outcomes and complications of therapeutic plasmapheresis, with particular significance on the role of pathology and transfusion medicine services. A PRISMA guided literature search observed 70 relevant studies, including randomized controlled trials, meta-analyses, registries and international guidelines. Recent evidence strongly upholds TPE as first-line therapy in selected conditions such as immune mediated thrombotic thrombocytopenic purpura, Guillain–Barre syndrome and myasthenic crisis. Potent implementation requires close integration between clinicians, pathologists and transfusion services, especially in resource-restricted healthcare systems.

Keywords: Therapeutic plasmapheresis, therapeutic plasma exchange, apheresis, transfusion medicine, PRISMA guidelines.


Outline