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Plasma exchange in neurological disease
  1. Chinar Osman1,
  2. Rachel Jennings1,
  3. Khaled El-Ghariani2,
  4. Ashwin Pinto1
  1. 1 Neurosciences, Wessex Neurological Centre, Southampton, UK
  2. 2 Therapeutics and Tissue Services, NHS Blood and Transplant, Sheffield Teaching Hospitals NHS Trust and the University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Chinar Osman, Neurosciences, Wessex Neurological Centre, Southampton SO16 6YD, UK; chinar.osman{at}


Plasma exchange is a highly efficient technique to remove circulating autoantibodies and other humoral factors rapidly from the vascular compartment. It was the first effective acute treatment for peripheral disorders such as Guillain-Barré syndrome and myasthenia gravis before intravenous immunoglobulin became available. The recent recognition of rapidly progressive severe antibody-mediated central nervous system disorders, such as neuromyelitis optica spectrum disorders and anti-N-methyl-D-aspartate-receptor encephalitis, has renewed interest in using plasma exchange for their acute treatment also. In this review we explain the principles and technical aspects of plasma exchange, review its current indications, and discuss the implications for its provision in the UK.

  • neuroimmunology
  • evidence-based neurology
  • clinical neurology

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  • Contributors CO wrote the draft manuscript. RJ and KE-G contributed to the practicalities of PLEX. AAP reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by Marguerite Hill, Swansea, UK and Aisling Carr, London, UK

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