Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor provides Plasmapheresis?
A nephrologist, a kidney doctor, or a critical care doctor, an intensive care doctor, often performs it. Plasmapheresis is also called plasma exchange. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What it is
Therapeutic plasmapheresis is a treatment that removes, returns, or exchanges blood plasma or its parts outside the body. The procedure is done in a way similar to dialysis. Some blood is removed through a catheter. Plasma, the liquid part of the blood, is separated from the blood cells. The blood cells, along with replacement fluid, are returned to the body.
Why a doctor might recommend it
It filters the blood and removes harmful antibodies. It is used for numerous diseases. For some conditions, it can be done as a first-line treatment. For other conditions, the evidence of benefit is minimal, so treatment must be individualized. Before a kidney transplant, it can remove antibodies against the donor blood type from the person getting the kidney. People with rare causes of kidney disease, such as Goodpasture syndrome, may have plasmapheresis to treat their disease. It is also done after a kidney transplant to treat cases of antibody-mediated rejection.
How to prepare
No specific patient preparation is needed for this procedure.
Reasons it may not be used include the following.
- A known allergy to heparin.
- A known allergy to fresh frozen plasma or to replacement fluid.
What happens during it
You lie on your back. The catheter is connected to the machine tubing. The separated plasma is discarded by the machine, and the red blood cells are returned to you along with the replacement fluid. Your vital signs are watched closely throughout the procedure.
Recovery
After the procedure, blood for fibrinogen and calcium is sent for testing again. The care team's chart lists the total number of sessions planned. After a kidney transplant, you may need more plasmapheresis treatments before you leave the hospital.
Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort lasting two minutes or more, fainting, coughing up or vomiting blood, or bleeding that will not stop.
Risks and side effects
Common problems during or after plasma exchange include the following.
- Low calcium or low magnesium, which can happen because of the citrate that keeps blood from clotting.
- Low body temperature.
- Transfusion reactions, which are managed by treating the symptoms.
- Fluid and electrolyte imbalance.
- A tendency to bleed when fibrinogen and platelets are too low.
- Low blood pressure.
- Flushing.
- Nausea and vomiting.
Low calcium and magnesium are treated by giving calcium and magnesium through a vein. The most common problem is a short-lived drop in blood pressure.
Who performs it
It is routinely performed by critical care specialists, nephrologists, and dialysis technicians after specialized training. It was traditionally done in blood banks.
Common questions
Is plasmapheresis the same as plasma exchange?
Yes, plasma exchange is also called plasmapheresis.
Which conditions is plasmapheresis used for?
It is used for numerous diseases. For some, it can be done as a first-line treatment. For others, the evidence of benefit is minimal.
What is put back into my body?
Your red blood cells and a replacement fluid are put back into your body. The replacement fluid can be donor plasma or colloids.
Will I need more than one session?
Sessions are planned in advance, and the care team's chart lists the total number. After a kidney transplant, you may need more treatments before you leave the hospital.
How does a direct primary care or concierge doctor fit in?
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
Sources
- NCBI Bookshelf - StatPearls: Plasmapheresis
- National Institute of Neurological Disorders and Stroke - Guillain-Barre Syndrome
- National Kidney Foundation - Plasmapheresis and Blood-type Incompatible Kidney Transplant
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
