Why this matters for blood donors: a single plasma exchange session can use several units of donated plasma to replace what is removed. TPE is only possible where a plasma supply exists.
What it is
Therapeutic plasma exchange, also called plasmapheresis, is an extracorporeal treatment: blood is drawn continuously from a large catheter, run through a machine that separates the plasma (by a membrane filter or a centrifuge), and the plasma is discarded and replaced with a mix of donated plasma, albumin or synthetic fluids before the blood is returned. Because the antibodies driving IMHA and ITP live in the plasma, removing one to two plasma volumes can strip out most of them in a single session.1 A typical course is two to four sessions on consecutive days.
Who gets it
- Dogs with severe IMHA who keep needing transfusions while waiting for drugs to work, or who aren't responding to immunosuppression.1,2
- Dogs with ITP and life-threatening bleeding.3
- Other immune diseases such as myasthenia gravis, and some poisonings where the toxin binds to plasma proteins.
It requires an extracorporeal therapy unit and a trained team, so it's offered mainly at university hospitals and a handful of large specialty centers. Ask your specialist if it's available; some hospitals refer for it.
What the research says
- The largest study, 146 dogs with immune-mediated blood disorders at one hospital, compared 17 treated with membrane TPE plus drugs against 129 treated with drugs alone. The TPE dogs were biased toward the sickest, refractory cases, and still had a similar outcome, which the authors read as evidence TPE helps in the dogs that need it most.1
- Case series in IMHA2 and ITP3 report rapid drops in autoantibodies and clinical improvement in most dogs, with complications including low calcium from the citrate anticoagulant, low blood pressure and catheter problems.
- Prescription, anticoagulation and metabolic effects of membrane TPE have been described in detail for dogs, giving hospitals a protocol to follow.4
- It is not a cure. Dogs still need immunosuppressive drugs afterward; TPE buys control of the crisis.
The MSPCA-Angell Animal Medical Center in Boston has a readable clinical explainer: Therapeutic plasma exchange, an emerging treatment for canine IMHA.
How you can help
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Research and references
Peer-reviewed sources for what's on this page. Each link runs a PubMed search for the paper so you land on the abstract, and often the full text.
- 1Francey T, Etter M, Schweighauser A. Evaluation of membrane-based therapeutic plasma exchange as adjunctive treatment for immune-mediated hematologic disorders in dogs J Vet Intern Med. 2021;35(2):925-935. PubMed
- 2Crump KL, Seshadri R. Use of therapeutic plasmapheresis in a case of canine immune-mediated hemolytic anemia J Vet Emerg Crit Care. 2009;19(4):375-380. PubMed
- 3Kopecny L, Palm CA, Naylor S, Kirby J, Cowgill LD. Application of therapeutic plasma exchange in dogs with immune-mediated thrombocytopenia J Vet Intern Med. 2020;34(4):1576-1581. PubMed
- 4Francey T, Schweighauser A. Membrane-based therapeutic plasma exchange in dogs: Prescription, anticoagulation, and metabolic response J Vet Intern Med. 2019;33(4):1635-1645. PubMed