Plasmapheresis for Waldenstrom macroglobulinemia

When the level of IgM gets very high, the blood becomes very thick (viscous). This is called hyperviscosity syndrome and can lead to brain damage (like a stroke) and bleeding problems. When that happens, the level of the abnormal IgM protein needs to be lowered right away.

Plasmapheresis does this using a machine that separates the plasma (the liquid part of the blood) that contains the abnormal protein from the blood cells. The blood cells are mixed with salt solution and new plasma and given back to the patient. The plasma containing the abnormal protein is discarded. Each plasmapheresis treatment takes a few hours.

A person having plasmapheresis can lie in bed or sit in a reclining chair. Two IV lines are required —- the blood is removed through one IV, and then is returned to the body through the other IV. Sometimes, a single large catheter is placed in the neck or under the collar bone for the pheresis —- instead of using IV lines in the arms. This type of catheter is called a central line and has both IVs built in. Plasmapheresis is not painful, but it can be hard to stay sitting or lying down in the same place for 2 or 3 hours. Also, sometimes calcium levels can drop on pheresis, causing numbness and tingling (especially in the hands and feet and around the mouth) and sometimes painful muscle spasms. These can easily be treated by giving the patient calcium.

Plasmapheresis works quickly to get the IgM level down to a safe level. However, without further treatment to kill the cancer cells (like chemotherapy) the protein level will go back up again. Plasmapheresis is usually given to help the patient until chemotherapy has a chance to work. Sometimes plasmapheresis is used for those whose Waldenstrom macroglobulinemia is not controlled by chemotherapy, biological therapy, or other treatments. When patients have symptoms from elevated IgM, they need to have plasmapheresis right away to prevent complications.