IVIg vs Plasmapheresis

April 9, 2010 at 2:36 pm

Dear Cathie,

One reason, and probably the most common reason, is because not all hospitals are equipped for plasmapheresis treatments. There have been published articles that the outcome of either are equally effective. However, if there were a possibility of both treatments being done on a patient, the plasmapheresis should be done first because the blood system and plasma would be cleansed before receiving the new antibodies from the IVIg. This would give the patient the benefit of both treatments.

The most relevent immuno-modulatory actions of IVIg, operating alone or in combination, are inhibition of complement deposition, neutralization of cytokines, modulation of Fc-receptor-mediated phagocytosis, and down regulation of autoantibody production. Cytokines are proteins (usually GlycoProteins) of relatively low molecular mass and often consisting of just a single chain. They are signaling chemicals secreted by various Leukocytes (white blood cells that fight infections), to activate other cells, which regulate all important biological processes: Cell Growth, Cell Activation, Inflammation, Immunity, Tissue Repair, Fibrosis and MorphoGenesis. FcR (Fiber cell Receptor) controls the catabolism of IgG in the adult body, allowing IgG to be recycled to the cell surface and back into the bloodstream. IVIg consist of approx 90% IgG (Gama) immunoglobulin antibodies. IVIg can also reduce autoantibody levels through neutralization mechanisms such as down-regulation of antibody production — slow/stop demyelination processes.

Plasmapheresis requires the blood to be centrifuged to separate the blood cells from the plasma. This is required because the bad autoantibodies that attack the myelin are located in the plasma. After plasma separation, the blood cells are returned to the patient, while the plasma, which contain the bad autoantibodies, is discarded and the patient receives, albumin with added proteins. Medication to keep the blood from clotting (an anticoagulant) is generally given to the patient during the procedure. The body will reproduce new plasma within 24 hours. Plasmapheresis is usually given to GBS patients every other day, or every 3 days.

I get IVIg treatments but wanted to try Plasmapheresis just to see if I would do better with it. I was amazed that there was one gallon of plasma removed with each treatment. However, I could not feel any relief and had to stick with the IVIg treatments.

Warmest regards.