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September 12, 1986

The Utility of Therapeutic Plasmapheresis for Neurological Disorders

JAMA. 1986;256(10):1333-1337. doi:10.1001/jama.1986.03380100107031

Therapeutic plasmapheresis, or therapeutic plasma exchange (TPE), is a method for removing toxic elements from the blood. It is performed by removing blood, separating the plasma from the formed elements, and reinfusing the formed elements together with a plasma replacement.

Therapeutic plasma exchange has been used to remove unwanted substances from the blood. These include toxins, metabolic substances, and plasma constituents implicated in disease, such as complement or antibodies. The ability to remove antibody and other immunologically active substances from the blood has led to the use of TPE as a therapy for neurological conditions in which autoimmunity is believed to play a role. It is estimated that half of the 20 000 to 30 000 TPE procedures performed annually at present in the United States are done on patients with neurological disorders.

Reports regarding use of TPE in the medical literature have generated both enthusiasm and controversy. Clinical trials