Autoimmune diseases occur when the body’s immune system turns against itself, leading to inflammation and damage to vital organs. These conditions can be chronic and challenging to treat, often requiring advanced therapies. One such treatment gaining attention is plasma exchange (plasmapheresis), a procedure that offers hope for patients when traditional treatments fall short. By removing harmful antibodies and toxins from the bloodstream, plasma exchange can help reduce inflammation and improve overall health. 

In this article, we explore how plasma exchange works, its effectiveness in managing autoimmune diseases, and the costs associated with this life-changing therapy.

What does plasma exchange therapy do?

Plasma exchange is a technique that removes harmful substances like antibodies from the bloodstream, which contribute to autoimmune reactions. 

After removing the plasma, it is replaced with a solution, typically saline or albumin, to maintain blood volume and support immune system balance. Let’s have a look at how this procedure is done:

• Blood collection: Blood is drawn from a vein.
• Separation: The blood passes through a plasmapheresis machine that separates plasma from other blood components (red blood cells, white blood cells, platelets).
• Plasma removal: The plasma containing harmful antibodies is discarded.
• Replacement: The remaining blood components are returned to the patient, along with replacement fluids like saline or albumin, to stabilise blood volume and protein levels.

What is plasma replacement therapy for autoimmune disease?

Plasma exchange is commonly used to treat autoimmune diseases like lupus, myasthenia gravis, multiple sclerosis, and rheumatoid arthritis, where the immune system attacks the body’s own tissues. It helps by:

• Removal of harmful antibodies: In autoimmune diseases, the immune system makes antibodies that target the body’s healthy cells. By removing the plasma, which contains these antibodies, plasma exchange helps reduce the immune system's attack on the body.
• Depletion of immune complexes: Immune complexes are formed when antibodies bind to antigens, and they can cause inflammation and tissue damage. By removing these complexes, plasma exchange can help minimise inflammation and slow disease progression.
• Modulating the immune response: Plasma exchange can potentially reset the immune system, helping it recover from the overactive behaviour that characterises autoimmune diseases and ultimately improve immune system function.

What conditions benefit from plasma exchange?

Various autoimmune conditions benefit from plasma exchange, particularly when other treatments have been ineffective. Some of the most common conditions include:

• Myasthenia gravis: This is a condition where the body's immune system attacks the communication between nerves and muscles, causing weakness. Plasma exchange is used to quickly improve muscle strength, particularly during disease exacerbations.
• Lupus: In systemic lupus erythematosus (SLE), the immune system attacks various organs, leading to kidney damage, skin rashes, and other systemic issues. Plasma exchange can be helpful in severe cases, particularly when the kidneys are affected.
• Guillain-Barré syndrome (GBS): This is a rare condition where the immune system attacks the peripheral nervous system, leading to muscle weakness and paralysis. Plasma exchange can significantly improve the recovery time for individuals with GBS.
• Goodpasture’s syndrome: This is an autoimmune disorder where antibodies attack the lungs and kidneys. Plasma exchange is often used as part of the treatment regimen to remove these harmful antibodies.

What to expect during plasma exchange?

Plasma exchange is performed in a hospital or specialised centre, typically over several hours, with multiple sessions depending on the condition's severity. The procedure involves:

1. Preparation: Before the procedure, a doctor will explain the process and the risks involved. Blood tests may be done to evaluate the patient's condition.
2. Blood Collection: A needle is inserted into a vein (or catheter for large volume exchanges) to draw blood.
3. Plasma Separation: The blood is sent through a machine that separates the plasma from the rest of the blood components. The plasma is removed and discarded.
4. Replacement: The remaining blood components are returned, along with replacement fluids like saline or albumin.
5. Post-Procedure Care: Patients may experience temporary fatigue or low blood pressure and are monitored until stable.

What are the benefits of plasma exchange?

Plasma exchange offers several benefits, including:

• Rapid Improvement: Quick relief, especially during severe flare-ups of autoimmune diseases.
• Reduced Inflammation: Removal of harmful substances helps lower inflammation and tissue damage.
• Temporary Immune Suppression: Temporarily suppressing the immune system aids in controlling autoimmune attacks.

What are the risks of plasma exchange?

While plasma exchange is highly effective, it does come with some risks that patients should be aware of:

• Infection: As with any procedure involving a needle, there is a small risk of infection.
• Low blood pressure: Some patients may experience a drop in blood pressure during or after the procedure.
• Allergic reactions: Some people may have allergic reactions to the replacement fluids used in the procedure.
• Clotting issues: There is a potential risk of clot formation when blood is removed and returned to the body.

What is the cost of plasma exchange?

The cost of plasma exchange in India can vary depending on the healthcare facility, the complexity of the procedure, and the patient’s specific condition. 

• On average, a single plasma exchange session may cost between ₹1,50,000 to ₹4,50,000 or more. The total cost will depend on the number of sessions required.
• Health insurance coverage is crucial in determining out-of-pocket expenses for plasma exchange. Some insurance plans may cover the procedure if deemed medically necessary, while others may require prior authorisation or may only cover a portion of the cost. 
• Patients should contact their insurance provider to get detailed information on coverage and potential out-of-pocket expenses.

What is the role of human albumin in plasma exchange?

Human albumin is a key replacement fluid in plasma exchange. Alburel injection, containing the active ingredient Human Albumin, is used to replace the plasma removed during the procedure. This protein helps maintain blood volume and pressure, reducing complications like low blood pressure. 

By stabilising blood composition, human albumin supports immune function and aids in recovery from autoimmune disease flare-ups.

Wrapping up

Plasma exchange is a promising treatment for autoimmune diseases, offering symptom relief and slowing disease progression, especially when other therapies fail. While it carries risks and can be costly, its effectiveness makes it a valuable option in severe cases. If considering this treatment, consult your healthcare provider to understand its benefits, risks, and costs.