Plasmapheresis (Plasma Exchange) for Waldenstrom Macroglobulinemia

Plasmapheresis, also known as plasma exchange, is used to treat hyperviscosity syndrome caused by Waldenstrom macroglobulinemia (WM). This procedure uses a machine to remove abnormal IgM protein from the blood.

What is plasmapheresis and when is it used for WM?

If you have Waldenstrom macroglobulinemia (WM), your blood can become very thick (viscous) when the level of abnormal IgM protein gets very high. This is called hyperviscosity syndrome. It can lead to bleeding problems and brain damage, like a stroke. 

When this happens, the level of IgM needs to be lowered right away. This is often done with a procedure called plasmapheresis, or plasma exchange.

The abnormal IgM protein is located in plasma, the liquid part of blood. Plasmapheresis uses a machine to remove the plasma from your blood cells. After the plasma is removed along with the abnormal protein, your blood cells are mixed with salt solution and plasma from a donor, then returned to your body.

How is plasmapheresis done?

Plasmapheresis takes a few hours. You are awake during the procedure, either lying in bed or sitting in a chair while your blood is removed through a large intravenous (IV) line or catheter.

The blood removed through the IV line goes through a machine where the plasma is replaced and then returned to your body.

Before the procedure, you might have a minor surgery to place the IV line in a large vein just below your neck or under your collarbone. This type of catheter, called a central line or central venous catheter (CVC), has two IVs built in. It allows for the blood to be removed and replaced. In some cases, two smaller IV lines are used instead, usually in your arms.

Is plasmapheresis painful?

Plasmapheresis isn’t painful, aside from the IV lines being put in, but some people find it hard to stay seated or lying down in the same place for 2 or 3 hours.

Calcium levels can drop in some people during treatment, causing numbness and tingling (especially in the hands, feet, and around the mouth) and muscle spasms which can sometimes be uncomfortable. This can be treated with calcium during the procedure.

Does plasmapheresis treat the cancer?

Plasmapheresis works quickly to bring down a high IgM level, but it doesn’t treat the cancer cells that caused the high level in the first place. So your IgM level will go back up again without further treatment like chemo or immunotherapy.

Plasmapheresis is usually given to reduce the amount of abnormal protein until chemotherapy or other drugs have a chance to work. It can also be used in people whose WM is not controlled by other treatments.