The fundamental basis for therapeutic plasmapheresis in autoimmune diseases

The application of therapeutic plasmapheresis (TP) to an autoimmune disease is made with careful attention to immunological mechanisms in the underlying disease process, its tempo, and its severity in the individual patient. The initial volume and frequency of TP, type of replacement plasma, and the type and intensity of any concomitant immuno-suppressive drug therapy are designed with regard to the management of the particular disease process. During a course of successive plasmaphereses, the initial treatment parameters are constantly under re-evaluation and adjustment to meet changes in the patient's medical status. Published protocols often are unnecessarily rigid because they derive from statistical considerations necessary for study design, and should be viewed as flexible guidelines. This article first deals with the fundamental basis for TP, and then examines selected disease specific protocols in this light. Copyright (C) 1996 Elsevier Science Ltd.