Introduction

This information is for people who have multiple sclerosis. It tells you about plasma exchange, a treatment used to help symptoms during a relapse of multiple sclerosis. It is based on the best and most up-to-date research.

Does it work?

We're not sure. If you've recently become much more disabled from your multiple sclerosis (MS), then plasma exchange may help you recover to some extent. But there hasn't been enough research to say for certain whether it will help you.

What is it?

During plasma exchange, the liquid part of your blood (called plasma) is taken out and plasma from someone else is put back in.

This treatment is sometimes called plasmapheresis.

Here's more on how it works:^[20]

• First, your blood is taken out through a tube

• A machine separates the plasma from the cells that make up the rest of your blood (such as red blood cells)

• These blood cells are mixed with replacement plasma

• The mixture of your own blood cells and the new plasma is returned to your body.

This isn't done all at once. You'll probably need several sessions over a few days or weeks.

Your doctor may suggest plasma exchange if steroids haven't worked.

You should only be advised to have this treatment by a specialist. Preferably, you should have this treatment as part of a study.^[2] If you have this treatment, you should be carefully monitored for side effects.

How can it help?

If you have a relapse of MS that is causing bad symptoms, and drugs called steroids haven't helped you to recover, then plasma exchange might help, although we don't know for sure.

There have only been two studies looking at this treatment for MS. One said it might help, and the other said it made little difference.^[76][77] We can't say for sure which study is more reliable.

How does it work?

If you have MS, your immune system attacks the coating around the nerves in your brain and spinal cord. Some of the substances that damage the coating of your nerves travel around your body in your blood. So, removing the plasma from your blood helps to get rid of these substances, at least until your body makes more plasma. This gives your nerves a chance to heal.

(To learn more about what happens in MS, see What is multiple sclerosis?)

Can it be harmful?

Researchers haven't reported any side effects from this treatment.^[77] But you can get problems from the tubes and needles used to remove your blood and put it back. For example, you can get an infection or have bleeding.

How good is the research on plasma exchange?

We found two studies (called randomised controlled trials) of plasma exchange for people with multiple sclerosis (MS) or a similar disease affecting the coating around their nerves.^[77][78]