Transplant Desentization with Plasma Exchange and IVIG
What is desensitization?
Desensitization removes antibodies from the blood. Antibodies are proteins that are produced by white blood cells to help the body fight infection. The making of antibodies is the body’s first line of defense in the immune process. These antibodies work hard to protect our bodies and keep us healthy. But, these same antibodies are bad for someone with a kidney transplant because they can attack or destroy a transplant kidney. Antibodies are created during a prior transplant, blood transfusion, or pregnancy. The process to remove antibodies is called plasmapheresis. It is similar to hemodialysis. In the desensitization process, you will need 2 – 4 plasmapheresis treatment before your transplant. You will also have these treatments after your transplant.
What is plasma exchange?
Plasma exchange is a process that removes the plasma and replaces it with healthy plasma. This process is also called pheresis.
Why do I need a plasma exchange?
Plasma, the fluid within your blood, has proteins in it. In certain diseases, these substances (autoantibodies) attack healthy cells. By doing a plasma exchange, we can remove some of the autoantibodies. This treatment makes it possible for you to have your transplant.
How is plasma exchange done?
During plasma exchange, blood is drawn from your arm and passed through a small tube (catheter). You may also need a catheter placed in a large vein in your neck or leg. The blood flows from the tube into a bag that is placed in a special machine that spins the blood (centrifuge). As the blood spins, it splits into plasma and blood cells (red cells, white cells, and platelets). The plasma is light and rises to the top of the bag. The plasma layer is then removed. The rest of the blood along with a plasma replacement is returned to your body through a small tube to your other arm. Only about one cup of blood is removed from your body at any given time.
What is used to replace the plasma?
The plasma that is removed is replaced by:
Albumin – a human blood product that has been screened and heat-treated to prevent disease from being transmitted. Side effects are rare, but may include nausea, fever, chills, itching, low blood pressure, or flushing.
Saline – a salt water solution.
Fresh frozen plasma – from healthy plasma given by blood donors and has been screened for viruses. Side effects may include itching, hives, chills, fever, and skin flushing. Rare side effects are labored breathing, low blood pressure, and allergic reaction. Be sure to tell your doctor or nurses if you notice any of these side effects.
How will I feel during the exchange?
Most people feel well during the exchange. Some have felt dizzy or light-headed. Slowing the rate of the exchange or lowering your head can help relieve these symptoms. Some people have numbness in the lips, and tingling in the hands and fingers. Chewing Tums® or drinking milk can help. Others are slightly sick to their stomach (nauseated). These symptoms often go away after the exchange is done. It will help if you eat something before the treatment. You may receive a medicine called Immune globulin (IVIG). It is given through an IV in your arm or a catheter in your neck. This medicine helps prevent the return of the antibodies or a rebound. The entire treatment takes 5 – 6 hours.
You may receive an IV medicine called mycophenolic acid (MPA). MPA is given in a vein in your arm or through the catheter in your neck. This medicine is an immunosuppressant. It helps to decrease rejection in transplant patients.
What are the side effects of MPA?
More common
Diarrhea
Fever
Stomach pain
Vomiting
Less Common
Burning with urination
Urinating more often
Rare
Black, tarry stools
Blood in urine or stools
Headache
Itching
Cough that won’t go away
Pinpoint red spots on skin
Rash
Tremors
Unusual bleeding or bruising
Caring for yourself after plasma exchange.
Most people feel tired. Plan on little or no activity for the next few hours.
If you are dizzy, lie down and raise your feet higher than your head.
For the next few hours, leave your bandages on and keep them dry.
Do not do any heavy lifting or exercise.
Since blood thinners are added to your blood to prevent clots from forming, you will be at risk for bruising and bleeding during the next 24 hours. Avoid contact sports and activities that would put you at greater risk.
If you have any redness or pain where the needle was placed, call the UWHC Infusion Center at 608-263-8369.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/13/2012
Copyright © 01/13/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5790
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