Plasma exchange Information for patients Sheffield Kidney Institute (Renal Unit)
Plasma exchange This leaflet explains about plasma exchange; the benefits, risks, alternatives and what you can expect when you come to hospital. If you have any further questions, please speak to a doctor or nurse caring for you. What is plasma? Plasma is the straw coloured fluid part of the blood, and contains: red blood cells white blood cells (that fight infection) antibodies (made to fight disease) proteins (some of them also help fight infection) platelets (the smallest type of blood cell that helps the blood to clot) other clotting substances that help control bleeding hormones The plasma carries these around the body to where they are needed. Why might I need plasma exchange? In some illnesses antibodies which normally help protect you from infection, attack your body s healthy cells and tissue, including those in the lungs and kidney. This can cause kidney failure. We call these illnesses autoimmune disorders. Plasma exchange may help with the symptoms of your illness. It will not normally cure your condition. Plasma exchange and drug treatment are used together to help remove the antibodies or other substances in your blood that are making you unwell. They will also help stop the body from producing any more. page 2 of 8
Plasma exchange is used in the treatment of: Vasculitis. We have another leaflet available that explains about this; please ask for a copy if you haven t been given one already. Haemolytic Uremic Syndrome (HUS). It can also be used in some cases for patients having a kidney transplant: To help stop the kidney transplant rejecting. In a type of kidney transplant where the blood group of the donor and the blood group of the person having the transplant aren t compatible (sometimes called an ABO incompatible transplant). What is plasma exchange? Plasma exchange is a procedure that uses a machine to separate and remove plasma from the blood and replace (exchange) it with new plasma fluid. The plasma that is filtered and removed will contain the toxins and antibodies which may be making you ill. The fluid used to replace your plasma in this procedure is either: Human Albumin Solution Octoplas Both of these are blood products and come from human donation. Some people may need an infusion at the end of the treatment, for example if there are problems with the blood clotting. page 3 of 8
What happens before the procedure? In order that plasma exchange can be carried out we need access to your blood supply. However, your normal veins would not be strong enough, so you will need an intravenous catheter called a dialysis line (or dialysis catheter) inserting. A dialysis catheter is a long tube made out of polyurethane (a strong, flexible man-made plastic) that divides into two separate lines. The catheter is put into a large vein in your chest but a part stays outside your body. The dialysis line stays in place until it is no longer needed. If you already have a dialysis fistula, this will be used for the procedure instead. We have another leaflet About your tunnelled dialysis catheter that tells you more about the dialysis catheter and how to look after it. Before the procedure starts we suggest you go to the toilet. If you can t or don t want to go to the toilet, you may have to use a bed pan or bottle. You may not be able to eat during the plasma exchange so we suggest you have something to eat and drink before the procedure. You will need blood tests before each plasma exchange. The results will be used to decide the exact plasma exchange treatment you need. page 4 of 8
What happens during plasma exchange? You will have your plasma exchange procedure on Renal Unit E Floor by a registered nurse trained in the procedure. They will monitor and look after you throughout the treatment. During the procedure: Your temperature, blood pressure, pulse and oxygen levels will be checked before, during and after the procedure. You will be monitored for any side effects and then given any other treatment if you need it. The machine will pump blood from one line of the dialysis catheter (or fistula needle) and return the blood through the other line. Your plasma is removed and the replacement plasma added as the blood passes through the machine. Only a small amount of blood passes through the machine at one time (about a mug full). The plasma is removed and replaced at the same time. As the blood in the tubing can clot, you will be given a drug that thins the blood and stops this from happening. You will be asked to lie on a bed during the procedure and to keep fairly still. To keep your calcium levels within normal limits you will be given a drug into the tubing set called calcium gluconate. Once the plasma exchange is complete, your blood in the tubing set will be given back to you and you will be disconnected from the machine. You may be asked to give your consent to your plasma being used for research. If this is the case with you, the doctor or nurse will explain this in detail. page 5 of 8
How long does the procedure take? The plasma exchange takes between two and three hours. This depends on: your weight how much plasma we need to exchange Plasma exchange can be daily or every other day for a total of seven procedures. Your doctor will let you know how many treatments you will need and a nurse from the renal unit will let you know when you are due your next plasma exchange. What happens after the procedure? Most people feel tired after the procedure. Whether you are staying in hospital or going home after the procedure you should try to rest. If you feel unwell or have any bleeding from the area where the line or needles were put in, tell your nurse straight away. If you are at home and are worried about your treatment, please contact the renal unit. We explain how to do this at the end of this leaflet. page 6 of 8
What are the possible problems with plasma exchange? For most people, plasma exchange is problem-free. The following are problems that some people have. Everyone is different so you could experience some, all or none of these. Pins and needles we use a substance called citrate to stop your blood from clotting in the machine. This can sometimes give you pins and needles around your mouth or in your arms and is due to a drop in the calcium levels in your blood. Reaction to the replacement fluids fever, chills, flushing, rash, shortness of breath, loin pain or a sudden allergic reaction (called anaphylaxis). Fainting Headaches Low blood pressure. All of these side effects can be treated quickly to reduce any discomfort you may experience. When will the dialysis line be removed? The dialysis line is normally taken out when all your plasma exchange sessions have finished. If your dialysis line is being used for haemodialysis treatment then the line may need to stay in for longer. Further information If you would like more information about plasma exchange see: www.nhsbt.nhs.uk/download/plasma-exchange-procedure.pdf page 7 of 8
Contact us If you have any questions or concerns about plasma exchange, please contact: Renal Unit E Floor 0114 271 5331 or 0114 226 9415 Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD9023-PIL3856 v2 Issue Date: June 2017. Review Date: June 2020