Plasmapheresis Treatment for Cold Agglutinin Disease

Cold agglutinin disease (CAD) is a type of autoimmune hemolytic anemia. In CAD, the immune system produces autoantibodies that mistakenly attack red blood cells and cause their premature destruction upon exposure to cold temperatures. Binding of the autoantibodies to the red blood cells causes them to clump together and break down rapidly, resulting in the various symptoms of CAD.

Plasmapheresis is a treatment that has been used to alleviate CAD symptoms in severe cases and for those who do not respond to other treatments.

What is plasmapheresis?

Plasma is the liquid portion of the blood, and contains antibodies in addition to other proteins, vitamins, and electrolytes. Plasmapheresis is a process in which the plasma from a patient’s blood is replaced with fresh plasma or a plasma substitute, thereby removing harmful components such as the autoantibodies. The removal of autoantibodies may help reduce damage to red blood cells and alleviate the symptoms of CAD.

Plasmapheresis does not slow the production of autoantibodies. Therefore, it may not prevent the reoccurrence of the symptoms. In some patients, more than one round of plasmapheresis may be required to see beneficial changes.

Before plasmapheresis

Before the procedure, doctors should be informed about all the medicines that the patient is taking as some medicines may interfere with plasmapheresis and may need to be stopped beforehand.

Patients are usually advised by their doctors to eat filling, nutritious meals and drink plenty of water on the day of treatment. Patients should adhere to any special meal instructions provided by their doctors and also avoid smoking, caffeine, and alcohol.

During plasmapheresis

Plasmapheresis is generally performed as an outpatient procedure using an apheresis system and the following steps:

  • Two needles attached to tubes are inserted into the veins of the patient, usually in the two arms.
  • A machine draws blood from one of the tubes and directs it to another machine that separates the blood into cells and plasma.
  • The plasma is transferred into a separate collection bag, and the same volume of fresh plasma or plasma substitute is mixed with the blood cells.
  • The mix of blood cells and new plasma is put back into the patient through the second tube.
  • The system processes the blood and plasma in an automated and continuous manner.

The duration of a single plasmapheresis treatment depends on the patient’s body type and the amount of plasma being replaced. The procedure can take anywhere between two and four hours.

After plasmapheresis

Plasmapheresis is usually a painless and safe procedure. Patients may experience a little soreness where the needles were inserted but this discomfort will dissipate with time.

After the procedure, the patient will be asked to rest, and if no problem is observed, he or she can go home.

Other information

In plasmapheresis, when the plasma is removed, helpful antibodies that protect the body are also eliminated along with the harmful ones. Patients must be careful to avoid any infections immediately after the treatment to prevent complications.

To prevent clotting during the procedure, blood is mixed with anti-coagulants, which may cause excessive bleeding in rare cases. The healthcare team should be notified immediately if excessive bleeding occurs.

Patients should also consult their healthcare team if they experience any of the following side effects after treatment:

  • Fever.
  • Chills.
  • Nausea or vomiting.
  • Dizziness.
  • Severe pain.
  • Allergic reactions to things used during the procedure such as syringes, gloves, medicines, or the new plasma.
  • Seizures.
  • Arrhythmia (irregular heartbeats).

Plasmapheresis can also be used as a treatment for other conditions including several autoimmune disorders such as multiple sclerosis, Lambert-Eaton myasthenic syndrome, and myasthenia gravis. The procedure can also be used to treat cancer and prevent transplant rejection.


Last updated: August 9, 2019


Cold Agglutinin Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.