Plasma exchange therapy in intensive care unit

Abstract

Plasma exchange (PE) is a therapeutic apheresis technique that allows centrifugation or filtration to separate plasma from blood cells and replace it. Among the indications, there are essentially pathologies in which the pathophysiology seems to be mediated by antibodies (polyclonal or monoclonal). The American Society for Apheresis (AFSA) publishes recommendations for good practice of apheresis techniques. These recommendations are progressive and see the appearance or withdrawal of indication to apheresis in the first line.  The place of plasma exchange in intensive care unit concerns only rare indications that must be known to clinicians allowing the rapid implementation of this technique. Indeed, certain pathologies such as hyperviscosity syndrome or thrombotic thrombocytopenic purpura (TTP) require urgent management. Apart from these formal indications, any other indication to the PE must be the subject of a collegial, multidisciplinary discussion in connection with the organ specialists.