Myasthenia Gravis and Plasmapheresis

[Guest guest]

Myasthenia

Gravis (MG) is an autoimmune disease. Under normal circumstances, the

body’s immune system protects against infection from invading bacteria

and viruses. In MG, the immune system produces antibodies that become

overactive and cause undesirable effects. These antibodies, called

acetylcholine receptor antibodies (AChR), destroy or block certain

receptor sites, resulting in muscle weakness. During plasmapheresis

(also called plasma exchange), these abnormal antibodies are removed

from the bloodstream.

What is plasmapheresis?

Plasmapheresis

is a procedure in which blood is separated into cells and plasma

(liquid). The plasma is removed and replaced with fresh frozen plasma,

a blood product called albumin and/or a plasma substitute. The

procedure is often referred to as plasma exchange.

Why should I have plasmapheresis?

Plasmapheresis

may be recommended for a few reasons:

To stabilize

a rapid decrease in muscle strength.

To reduce

moderate to severe muscle weakness before surgery.

To add to

present treatment if current forms of therapy are providing

insufficient control of the disease.

How many plasma exchanges will I need and where will

it be done?

The number of

plasmapheresis treatments needed depends on the protocol the physician

has determined is best for the patient. Some patients are treated on a

Monday/Wednesday/Friday schedule. Others are treated on a daily

schedule or on a weekly or monthly schedule. Hospitalization may be

necessary for treatment. Sometimes plasmapheresis can be done on an

outpatient basis.

What should I expect to happen?

A needle will be

placed in each arm. In some instances, only one arm may be used. If the

arm veins are too small to use, the physician may place a special long

duration indwelling catheter into a large vein in the shoulder or

groin. Unless the physician has instructed otherwise, it is important

to eat before the plasma exchange and not skip any meals. During plasma

exchange, the patient may drink fluids. The patient should empty the

bladder prior to the procedure and ask the nurse for a bedpan or urinal

if needed during the plasma exchange procedure. The patient will need

to keep both arms still unless the catheter is placed into a different

spot. Wearing comfortable clothing with loose fitting sleeves that pull

easily above the elbows will make it easier to place the needles in

each arm. Bringing something to read or to do will help pass the time

(e.g., a radio or tape/CD player with headphones). If the procedure is

being performed with an indwelling catheter, it may be necessary to

wear a hospital gown.

How long does plasma exchange take?

The time spent

on the machine may be one to three hours. This depends upon the

patient’s weight, height and the amount of plasma to be exchanged.

How will I feel after my plasma exchange?

Many patients

feel fine after the procedure. Others may feel tired. If the patient is

not staying in the hospital, someone should drive him/her home.

How soon will the treatment work?

Plasmapheresis

works quickly to increase strength. Most patients begin to improve

within the first few days of the treatment.

How long will the improvement last?

A typical

patient who has received three to five exchanges over a week or two

would commonly remain stronger for one to two months. After a month or

two, the acetylcholine receptor antibodies usually return to

pre-treatment levels in the bloodstream.

What are the possible adverse effects?

Common adverse

effects may include a drop in blood pressure, feelings of faintness,

dizziness, blurred vision, coldness, sweating or abdominal cramps.

Rare adverse

effects may include bleeding as a result of medications used to keep

the blood from clotting, tingling associated with the mouth, eyes,

fingers or toes and a possible allergic reaction to the solutions,

which may result in itching, wheezing or rash.

How do I reduce my fears about the plasmapheresis

procedure?

Often, anxiety

about plasmapheresis, especially during the first few treatments,can

produce some unusual sensations that will go away once the patient

becomes more comfortable with the procedure. Helpful ways to alleviate

fears may include speaking to someone who has been treated with

plasmapheresis, discussing concerns with the physician, seeking out the

coordinator of the plasmapheresis program or contacting the Myasthenia

Gravis Foundation of America, Inc.

Myasthenia Gravis Foundation of America, Inc.

http://www.myasthenia.org/information/

1821 University Ave W, Ste S256 • St. , MN 55104-2897

• • fax