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Therapeutic Plasma Exchange (TPE)

Jo FrowdeHello, I am Jo Frowde, ISN Guide to Therapeutic Plasma Exchange.. Therapeutic Plasma Exchange (TPE) is an extracorporeal therapy treatment, which has been used successfully for limited scleroderma. See Disclaimer.

Overview
TPE for Scleroderma
TPE for Other Diseases

Overview

Eagle MountainsTherapeutic plasma exchange (TPE) is a treatment that removes plasma from your blood, which is then replaced with a substitute. Plasma is the liquid portion of blood which helps carry blood cells and other substances throughout your body. Plasma exchange (plasmapheresis) is a way of separating plasma from blood cells.

Plasmapheresis is a term used to refer to a broad range of procedures in which extracorporeal separation of blood components results in a filtered plasma product. Medscape, 07/19/2017.

Therapeutic Plasma Exchange (TPE) is a procedure where a large volume of blood is extracted in a continuous flow process. The main blood components (red blood cells, white blood cells, and platelets) are separated from the plasma by a centrifugal process, and the extracted cells are re-combined with a plasma replacement such as sterilized albumin. The Scleroderma Education Project, SclerodermaInfo.org

Therapeutic Plasma Exchange (TPE) TPE removes large–molecular–weight substances such as harmful antibodies from the plasma and is normally combined with disease modifying treatment, such as immunosuppressive drugs, for the underlying condition. JPAC. (Also see Immunosuppressants)

The mechanisms of action of plasma exchange. This treatment has been applied to a wide variety of diseases but limited research has been published examining the mechanisms of action of TPE. PubMed, Br J Haematol.

TPE for Scleroderma

Successful long-term (22 year) treatment of limited scleroderma (SSc) using therapeutic plasma exchange (TPE): Is blood rheology the key? An explanation for the therapeutic benefits seen with TPE can be based on abnormal blood rheology as a novel disease pathogenesis model for SSc. PubMed, Clin Hemorheol Microcirc, 2017;65(2):131-136.

Sustained benefit from combined plasmapheresis (PE) and allogeneic mesenchymal stem cells transplantation (MSCT) therapy in systemic sclerosis. The results indicate that PE combined with MSCT is a feasible treatment associated with possible clinical benefit for SSc patients. PubMed, Arthritis Res Ther, 2017 Jul 19;19(1):165. (Also see Stem Cell Transplantation)

Scleroderma renal crisis (SRC) during intravenous cyclophosphamide pulse therapy for complicated interstitial lung disease (ILD) was successfully treated with angiotensin converting enzyme inhibitor and plasma exchange (PE). This study presents the possibility of favorable effects of PE for SSc–associated ILD and SRC. PubMed, Nagoya J Med Sci, 2016 Aug;78(3):329-34. (Also see Kidney (Renal) Involvement and Treatments for Pulmonary Fibrosis)

Therapeutic Plasma Exchange (TPE) for the Treatment of Systemic Scleroderma (SSc): A Comprehensive Review and Analysis. In contrast to current treatment modalities such as immunosuppression, the results shown in the clinical studies reviewed for this article suggest that long–term TPE may offer a low–risk way to control and in some cases reverse SSc. Researchgate, May 2016.

Case Report: 13–year history of scleroderma complicated by renal crisis (SRC) and thrombotic microangiopathy (TMA) treated with plasma exchange (PE). PE should be considered as a treatment option for SRC complicated by TMA. PubMed, Nihon Rinsho Meneki Gakkai Kaishi. (Also see Kidney (Renal) Involvement)

TPE for Other Diseases

Catastrophic antiphospholipid syndrome: an update. Treatment strategy is based on the combination of anticoagulation, glucocorticoids, plasma exchange and/or intravenous immunoglobulins. PubMed, Panminerva Med, 2017 Sep;59(3):254-268. (Also see Antiphospholipid Syndrome)

Specific removal of autoantibodies by extracorporeal immunoadsorption ameliorates experimental autoimmune myasthenia gravis. Plasmapheresis and IgG–immunoadsorption are useful therapy options, but are highly non–specific. PubMed, J Neuroimmunol, 09/06/2017. (Also see Myasthenia Gravis)

Improvement of quality of life after therapeutic plasma exchange in patients with myasthenic crisis. Therapeutic plasma exchange significantly improves the quality of life of patients with myasthenia gravis during the crisis. PubMed, Neurol Neurochir Pol, 2016 Nov - Dec;50(6):418-424. (Also see Myasthenia Gravis)

Clinical Trials in Vasculitis. This article discusses the treatment options of (ANCA)–associated vasculitis in light of evidence from clinical trials. PubMed, Curr Treatm Opt Rheumatol, 2016;2(2):161-177. (Also see Vasculitis)

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