Pediatric plasmapheresis (plasma exchange or PLEX)

Pediatric plasmapheresis (plasma exchange or PLEX) removes proteins from the blood to help children who have diseases of the immune system. Children’s Health℠ was one of the first pediatric hospitals in the U.S. to use plasmapheresis for a variety of diseases and ages, from infants to teenagers.

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What is pediatric plasmapheresis (plasma exchange or PLEX)?

Plasmapheresis is a process of filtering a child’s blood through a machine. It is often called plasma exchange, or PLEX, although they are not technically the same. Plasma exchange involves removing some proteins from the blood and adding others, whereas plasmapheresis only removes proteins.

Specifically, plasmapheresis removes proteins that are involved in causing damage to the child’s body. We use it when an autoimmune disease like transverse myelitis, optic neuritis, neuromyelitis optica, Anti-MOG Associated Disease, autoimmune encephalitis or multiple sclerosis attacks a child’s brain, spinal cord or optic nerve. Often these attacks cause inflammation (swelling) and other problems that require children to come to the hospital or ER. Plasmapheresis stops the attack so the child can get better.

To do that, we use a special IV (intravenous line) to connect a child to a machine. Their blood flows into the machine, which filters out the harmful cells. Then the blood flows back into the child’s body. The blood still has what the child needs to be healthy, but now it’s missing the particles that were causing harm.

What are the benefits of pediatric plasmapheresis (plasma exchange or PLEX)?

Sometimes autoimmune diseases attack healthy cells in the brain, spinal cord or optic nerve. This causes inflammation and damage to cells the body needs, which can lead to problems with vision, movement, sensation or cognition.

Plasmapheresis stops this process by removing the specific immune system proteins that are coordinating or causing the attack. The autoimmune disease is still present, but for the moment we’ve taken away the fuel it needs to do harm. This reduces inflammation and damage, allowing the child’s symptoms to go away and their bodies to recover.

What are the side effects of pediatric plasmapheresis (plasma exchange or PLEX)?

Side effects are usually minor and easy to treat. Some children feel tired during or immediately after treatment. Some feel dizzy, because of a drop in blood pressure. We treat this with fluids and by slowing down the rate of the machine.

Plasmapheresis lowers the level of calcium in the blood. This can lead to muscle cramps or tingling sensations, often in the fingertips or lips. We give extra calcium to children with these symptoms.

What are the risks of pediatric plasmapheresis (plasma exchange or PLEX)?

We insert a special IV in your child’s shoulder, neck or arms to connect them to the machine. For babies, inserting the IV risks damaging their blood vessels, because the vessels are so small. Our teams are experienced in treating babies and avoiding these problems.

For children of any age, the access points for IVs can become infected with bacteria. We pay special attention to how we clean and handle those access points to keep that from happening.

A child’s blood pressure can drop during treatment. There is also a risk of bleeding, because plasmapheresis takes away some of the blood’s ability to clot (stop bleeds on its own). We watch for these risks and can respond with medication or other treatment if they occur.

What are Children’s Health’s outcome metrics for pediatric plasmapheresis (plasma exchange or PLEX)?

In 2018, we studied patients with transverse myelitis (TM) to see how safe and effective plasmapheresis is for them. Almost 80% of patients in the study saw major improvement after treatment. Out of 114 treatments, only four sessions involved some sort of complication. We were able to manage all of them without delay.

What to expect with pediatric plasmapheresis (plasma exchange or PLEX)

Most children who receive plasmapheresis have been admitted to the hospital because of their condition. They receive five to seven sessions of plasmapheresis over the course of one to two weeks. Each session lasts about 90 minutes.

Your child should drink fluids prior to treatment. Otherwise, no special preparation is necessary.

What questions should I ask my provider about pediatric plasmapheresis (plasma exchange or PLEX)?

We recommend asking the team who will do the treatment a few questions, such as:

Do you have experience with children the same age and size as mine?
What does your team do to prevent infections?
How do you respond to side effects or infections if they occur?

Frequently Asked Questions

Will pediatric plasmapheresis (plasma exchange or PLEX) suppress my child’s immune system?

Not very much. This treatment removes specific immune system proteins from the blood, but the immune system remains strong overall. Plasmapheresis does not kill or remove any of the cells of the immune system.
How effective is pediatric plasmapheresis (plasma exchange or PLEX)?

In our experience, it is very effective. In our study from 2018, almost 80% of patients with transverse myelitis (TM) saw major improvements after treatment.