Plasmapheresis (Plasma Exchange):
- Definition: Plasmapheresis, also known as therapeutic plasma exchange, involves removing the **plasma portion** of a patient’s blood and replacing it with either **albumin** or fresh plasma.
- Mechanism of Action:
Plasmapheresis removes pathogenic antibodies that interfere with neuromuscular function.
By eliminating these antibodies, normal neuromuscular activity is restored.
- Indications:
Effective in chronic inflammatory demyelinating polyneuropathy, Guillain-Barré-syndrome (GBS) in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome, and myasthenia gravis exacerbations (but not stable disease).
Considered for Lambert-Eaton myasthenic syndrome and pediatric Guillain-Barré-syndrome (GBS).
Not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy, and small fiber neuropathy.
- Clinical Use: Often used in the ICU for neuromuscular disorders.
Intravenous Immunoglobulins (IVIG):
- Definition: IVIG is a therapy containing healthy antibodies from blood donors, administered intravenously.
- Mechanism of Action:
High doses of IVIG can block damaging antibodies associated with GBS and myasthenic crisis.
- Indications:
Recommended for **chronic inflammatory demyelinating polyneuropathy**, GBS in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome, and myasthenia gravis exacerbations (but not stable disease).
Also useful for **Lambert-Eaton myasthenic syndrome** and pediatric GBS.
Not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy, and certain small fiber neuropathies.
- Clinical Use: IVIG remains a mainstay of treatment in the ICU for many neuromuscular disorders.
Source:
(1) Newer Immunotherapies for the Treatment of Acute … – Springer. https://link.springer.com/article/10.1007/s11940-020-0616-8.
(2) Updated consensus statement: Intravenous immunoglobulin in the …. https://www.aanem.org/docs/default-source/documents/practice/consensus-statement–ivig-treatment-nmd.pdf?sfvrsn=1c910a7f_1.
(3) Plasmapheresis treatment in Guillain-Barré Syndrome: potential benefit …. https://journals.sagepub.com/doi/pdf/10.1177/0310057X1003800225.
(4) SPECIAL ARTICLE Evidence-based guideline update: Plasmapheresis in …. https://www.neurology.org/doi/pdf/10.1212/WNL.0b013e318207b1f6.
(5) Guillain-Barre syndrome – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/diagnosis-treatment/drc-20363006.
(6) Facts About Plasmapheresis – Muscular Dystrophy Association. https://www.mda.org/sites/default/files/publications/Facts_Plasmapheresis_P-206_0.pdf.
(7) The Self-Confirmatory History of Plasmapheresis and IVIG – Springer. https://link.springer.com/article/10.1007/s12028-024-01968-6.
(8) Progress in Guillain–Barré syndrome immunotherapy—A narrative review of …. https://www.tandfonline.com/doi/pdf/10.1080/21645515.2023.2215153.
(9) Myasthenic crisis | Deranged Physiology. https://derangedphysiology.com/main/required-reading/neurology-and-neurosurgery/Chapter%202092/myasthenic-crisis.
(10) en.wikipedia.org. https://en.wikipedia.org/wiki/Plasmapheresis.
Verified by Dr. Petya Stefanova
