Systemic lupus erythematosus (SLE) is an autoimmune disease where the immune system produces antibodies that attack the body’s own tissues. In most people with lupus, treatment with corticosteroids and immunosuppressive medications helps control inflammation and reduce flares. But for some patients, standard medications are not enough, and the disease continues to damage organs- particularly the kidneys.
Plasmapheresis treatment for lupus is a medical procedure that physically removes harmful antibodies and immune complexes from the bloodstream. For patients who have not responded adequately to conventional treatment, it may offer a meaningful way to bring severe disease activity under control.
What Happens to the Blood in Lupus
In lupus, the immune system generates autoantibodies- proteins that mistakenly target the body’s own DNA, cell membranes, and other structures. These autoantibodies bind to tissues and trigger a cascade of inflammation. In the kidneys, this produces lupus nephritis, a form of kidney inflammation that can progress to organ failure if left untreated (Waldman & Appel, Kidney Int., 2006).
When disease activity is severe- for example, in class III or IV lupus nephritis, or when antiphospholipid syndrome is present- the autoantibody load may be too high for immunosuppressive medications to resolve quickly enough. That is where plasmapheresis for lupus may play an important role.
How Plasmapheresis Works
Plasmapheresis- also called therapeutic plasma exchange- involves withdrawing blood from the patient, separating the plasma (the liquid portion) from the blood cells, and replacing it with fresh plasma or a plasma substitute. The discarded plasma contains harmful autoantibodies and immune complexes, effectively removing a large portion of them from circulation in a single session.
The procedure typically takes two to three hours per session and is performed through a catheter or large IV access. A course of treatment generally involves five to seven sessions over one to two weeks. Most patients tolerate the procedure well, though temporary effects such as lightheadedness or fatigue are possible during or after a session.
This approach does not treat the underlying immune dysfunction- it works alongside disease-modifying therapies to reduce the immediate autoantibody burden.
Who May Benefit from Plasmapheresis for Lupus
Not every lupus patient needs or benefits from plasmapheresis. It is typically considered in specific situations where autoantibodies are directly causing serious, acute complications that are not responding to standard treatment.
These may include:
- Severe lupus nephritis (class III, IV, or V) unresponsive to immunosuppression
- Thrombotic thrombocytopenic purpura (TTP) associated with lupus
- Catastrophic antiphospholipid syndrome (CAPS)
- Cryoglobulinemia or pulmonary hemorrhage with SLE
- Rapidly progressive disease requiring urgent reduction of autoantibody burden
A landmark controlled trial by Lewis et al. published in the New England Journal of Medicine examined plasmapheresis therapy in patients with severe lupus nephritis and found it to be a feasible adjunctive intervention in this difficult-to-treat patient population (Lewis et al., N Engl J Med., 1992).
Plasmapheresis for Systemic Lupus Erythematosus: Current Evidence
The role of plasmapheresis for systemic lupus erythematosus has been studied most extensively in the context of lupus nephritis and other organ-threatening complications. Because lupus presents differently in each person, the evidence base reflects its selective use in well-defined clinical scenarios rather than as a routine therapy.
A review published in Autoimmunity Reviews outlined the evolving landscape of treatment approaches for refractory lupus nephritis- the form of lupus kidney disease that does not adequately respond to standard immunosuppression. Plasmapheresis was noted among the interventions used in settings where autoantibody-mediated damage is severe and rapid reduction of immune complexes is needed (Kronbichler et al., Autoimmun Rev., 2019).
The procedure is also used in combination with cyclophosphamide as part of a “synchronization” approach: plasmapheresis removes existing autoantibodies, and cyclophosphamide is administered shortly after to suppress their re-production. Research on immunoadsorption- a similar technique- has further supported this approach for autoimmune disease management (Braun & Risler, Ther Apher., 1999).
What the Procedure Involves
Patients undergoing this treatment approach will typically receive the procedure in a clinical setting with appropriate monitoring. The process involves:
Access: A peripheral IV or central venous catheter is placed to allow blood to be drawn and returned.
Separation: Blood passes through a machine that separates the plasma from red cells, white cells, and platelets.
Replacement: The plasma- which contains the autoantibodies- is discarded, and the cellular components are returned to the patient with fresh frozen plasma or albumin solution.
Monitoring: Vital signs, electrolytes, and clotting factors are monitored throughout the session.
The treatment works as an adjunct to ongoing disease management, not as a standalone solution. Patients continue their lupus medications during and after the course of plasmapheresis.
Frequently Asked Questions
Most treatment courses for lupus involve five to seven sessions, typically performed every other day over approximately two weeks. The exact number depends on the severity of disease activity and the clinical response observed during treatment.
Most treatment courses for lupus involve five to seven sessions, typically performed every other day over approximately two weeks. The exact number depends on the severity of disease activity and the clinical response observed during treatment.
The procedure itself is not typically painful. Most patients experience mild discomfort from the catheter placement. Some people report feeling cold, lightheaded, or fatigued during the session, which can be managed with supportive measures.
No. Plasmapheresis does not address the root cause of autoantibody production. It is used alongside immunosuppressive medications- not instead of them- to help manage severe or refractory disease flares.
Therapeutic plasma exchange is available at select clinics offering regenerative and functional medicine services. A medical consultation is needed to determine whether this approach is appropriate for your specific clinical situation.
Key Takeaways
- This procedure physically removes harmful autoantibodies from the bloodstream
- It is typically used in severe or refractory lupus nephritis, TTP, and catastrophic antiphospholipid syndrome
- The procedure is an adjunct to immunosuppressive therapy- not a standalone treatment
- A typical course involves 5–7 sessions over 1–2 weeks
- Clinical evaluation is essential to determine whether a patient is a suitable candidate
- Monitoring with regular bloodwork helps guide treatment decisions
To learn more about plasmapheresis therapy or plasma exchange available through Ways2Well, or to discuss whether this approach may be appropriate for you, schedule a consultation with our medical team.
References
- Lewis EJ, Hunsicker LG, Lan SP, Rohde RD. “A controlled trial of plasmapheresis therapy in severe lupus nephritis.” N Engl J Med. 1992;326(21):1373–1379. DOI: https://doi.org/10.1056/NEJM199205213262101
- Kronbichler A, Brezina B, Gauckler P, Quintana LF, Jayne DRW. “Refractory lupus nephritis: When, why, and how to treat.” Autoimmun Rev. 2019;18(5):510–518. DOI: https://doi.org/10.1016/j.autrev.2019.03.009
- Waldman M, Appel GB. “Update on the treatment of lupus nephritis.” Kidney Int. 2006;70(8):1403–1412. DOI: https://doi.org/10.1038/sj.ki.5001786
- Braun N, Risler T. “Immunoadsorption as a tool for the immunomodulation of the humoral and cellular immune system in autoimmune disease.” Ther Apher. 1999;3(3):240–245. DOI: https://doi.org/10.1046/j.1526-0968.1999.00152.x
Author: Ways2Well Editorial Team
Reviewed by: Scientific Advisory Board member