Therapeutic Plasma Exchange in Adult Critical Care
A practical adult ICU guide for building, delivering, and reassessing an indication-specific therapeutic plasma exchange prescription.
On this page
- Definition, purpose, and scope
- Indication, target, and endpoint
- Write the platform-neutral prescription
- Estimate plasma volume and prescribe the exchange
- Example first-session volume calculation
- Verified indication-specific courses
- Replacement-fluid prescription
- Technique, vascular access, and extracorporeal volume
- Anticoagulation and calcium plan
- Baseline, procedural, and course monitoring
- Complications: recognize, pause, treat, reassess
- Medication and biologic timing
- Translate the completed prescription to the device
- Clinical and circuit troubleshooting
Definition, purpose, and scope
Therapeutic plasma exchange (TPE) removes plasma while returning cellular blood components with a prescribed replacement fluid. Use it only when evidence for the exact disease presentation supports removing a pathogenic circulating substance and/or replacing a deficient plasma component.
This guide supports adult critical-care prescribing and procedure oversight. It does not replace an apheresis specialist, an indication-specific disease pathway, a transfusion policy, or the instructions for the installed device; pediatric, neonatal, and pregnancy prescriptions require population-specific review.
Indication, target, and endpoint
- Name the target
Identify the antibody, paraprotein, immune complex, toxin, or other plasma constituent to be removed; account for intravascular availability, ongoing production, and redistribution between sessions.
- Name what must be replaced
State whether replacement only preserves circulating volume or must also supply a clinically important plasma component, such as ADAMTS13 or haemostatic factors.
- Name the stopping rule before starting
Use the disease-specific endpoint: a fixed verified course, a laboratory target, control of bleeding or hyperviscosity, or another explicit clinical response. Do not continue simply because a calculated plasma volume remains available.
Write the platform-neutral prescription
Complete all ten elements before translating the order to a device. If one cannot be specified from the indication pathway, pause and obtain apheresis or disease-specialist review.
Indication and urgency — record the exact disease presentation, TPE role, time sensitivity, exclusions, and the specialist responsible for the endpoint.
Therapeutic target — state the substance to remove or component to replace and how rebound or ongoing production affects the interval.
Estimated plasma volume — document the formula or validated method, current sex, height, weight, haematocrit, population limits, and the calculated value.
Exchange dose — multiply the unrounded estimated plasma volume by the indication-specific exchange multiple; write the resulting session volume and permitted rounding.
Replacement and balance — prescribe albumin, plasma, or a named mixture; specify composition, sequence if relevant, and the intended net patient fluid balance.
Course and endpoint — prescribe session frequency, planned number or stop rule, required reassessment, and what triggers escalation, delay, or discontinuation.
Technique and access — choose centrifugal or membrane separation, a compatible vascular access, and a plan for extracorporeal volume, priming, and warming.
Anticoagulation and calcium — name the method-specific strategy, monitoring, citrate-risk assessment, calcium prevention/rescue plan, and bleeding or thrombosis constraints.
Monitoring — define baseline tests, observations during exchange, post-session tests, adverse-event readiness, and disease-response measurements.
Medication timing — review continuous infusions, antimicrobials, anticoagulants, immunoglobulins, and biologics; specify administration, sampling, and any drug-specific replacement plan.
Estimate plasma volume and prescribe the exchange
For adults weighing at least 25 kg, the linked calculator applies the sex-specific Nadler equation, then calculates estimated plasma volume as total blood volume × (1 − haematocrit/100). Below 25 kg it uses a separate weight-based branch, which is outside this adult guide. Nadler was derived in normal adults; assess its suitability when body composition or intravascular volume is markedly altered.
Use only the Total Blood Volume and Plasma Volume results from the linked calculator when following this guide. Its default 30% Removal Percentage, 1.05 Correction Factor, and Removed Plasma Volume result are calculator fields, not a TPE prescription. Select the exchange multiple from the exact indication row or specialist pathway, then calculate session exchange volume = unrounded estimated plasma volume × prescribed multiple.
The current calculator displays total blood volume to 0.1 L and plasma volume to 0.01 L. Carry the unrounded plasma volume into multiplication, round the final worked-example target to 0.01 L, and separately verify the units and rounding used for the clinical order and active device.
Example first-session volume calculation
This example illustrates volume calculation only. It does not determine the indication for TPE, target exchange volume, replacement fluid, anticoagulation method, treatment frequency, or course duration. Example patient: a 70 kg, 1.75 m adult male with a haematocrit of 40%.
- Patient data
Weight: 70 kg; height: 1.75 m; sex: male; haematocrit: 40%.
- Estimated total blood volume
Male Nadler equation: 0.3669 × 1.75³ + 0.03219 × 70 + 0.6041 = 4.8237546875 L, or approximately 4.82 L.
- Estimated plasma volume
Plasma volume = blood volume × (1 − haematocrit): 4.8237546875 × (1 − 0.40) = 2.8942528125 L, or approximately 2.89 L.
- Target exchange volume: 1.0 plasma volume
2.8942528125 × 1.0 = 2.8942528125 L. After final rounding, the target exchange volume is 2.89 L.
- Target exchange volume: 1.5 plasma volumes
2.8942528125 × 1.5 = 4.34137921875 L. After final rounding, the target exchange volume is 4.34 L. Intermediate values should remain unrounded.
Verified indication-specific courses
Use a row only for its stated presentation and guidance set. Each row includes the role, session dose/course, replacement fluid, and endpoint; do not transfer a regimen between diseases.
| Disease presentation | Role | Exchange dose and course | Replacement fluid | Endpoint |
|---|---|---|---|---|
| First acute or relapsing immune thrombotic thrombocytopenic purpura (iTTP) under an urgent specialist TTP pathway. | Emergency main treatment; the BSH pathway aims to start TPE within 4 hours of presentation. Use with corticosteroids and other disease-directed therapy according to the current iTTP pathway. | Exchange 1.5 calculated plasma volumes daily until evidence of response, then reduce to 1.0 plasma volume daily. | Solvent/detergent-treated fresh frozen plasma only in the cited BSH UK regimen; replacement supplies functional ADAMTS13. | Continue daily until the platelet count is normal for 3 consecutive days, with ongoing specialist assessment of clinical response. |
First acute or relapsing immune thrombotic thrombocytopenic purpura (iTTP) under an urgent specialist TTP pathway.
- Role
- Emergency main treatment; the BSH pathway aims to start TPE within 4 hours of presentation. Use with corticosteroids and other disease-directed therapy according to the current iTTP pathway.
- Exchange dose and course
- Exchange 1.5 calculated plasma volumes daily until evidence of response, then reduce to 1.0 plasma volume daily.
- Replacement fluid
- Solvent/detergent-treated fresh frozen plasma only in the cited BSH UK regimen; replacement supplies functional ADAMTS13.
- Endpoint
- Continue daily until the platelet count is normal for 3 consecutive days, with ongoing specialist assessment of clinical response.
| Disease presentation | Role | Exchange dose and course | Replacement fluid | Endpoint |
|---|---|---|---|---|
| Impending or manifest myasthenic crisis, or severe exacerbation with significant respiratory or bulbar dysfunction. | Short-term rescue alongside airway/ventilatory support and disease-directed therapy; not a routine maintenance prescription. | Five exchanges of 1.0 calculated plasma volume at daily or alternate-day intervals. | 4.5% or 5% human albumin solution. | Complete the verified five-exchange crisis course while reassessing respiratory and bulbar function; any further exchange requires a new specialist indication. |
Impending or manifest myasthenic crisis, or severe exacerbation with significant respiratory or bulbar dysfunction.
- Role
- Short-term rescue alongside airway/ventilatory support and disease-directed therapy; not a routine maintenance prescription.
- Exchange dose and course
- Five exchanges of 1.0 calculated plasma volume at daily or alternate-day intervals.
- Replacement fluid
- 4.5% or 5% human albumin solution.
- Endpoint
- Complete the verified five-exchange crisis course while reassessing respiratory and bulbar function; any further exchange requires a new specialist indication.
| Disease presentation | Role | Exchange dose and course | Replacement fluid | Endpoint |
|---|---|---|---|---|
| Suspected or confirmed anti-GBM glomerulonephritis with kidney salvage potential and/or alveolar haemorrhage. The KDIGO exception applies only when all conditions are met: dialysis dependence at presentation; an adequate biopsy showing either crescents in 100% of glomeruli or global glomerulosclerosis in more than 50% of glomeruli; and no pulmonary haemorrhage. | Start without delay as part of combined therapy with glucocorticoids and cyclophosphamide; TPE is not stand-alone treatment. | Exchange 40–50 mL/kg ideal body weight daily. | 5% albumin; add fresh frozen plasma at the end of exchange for alveolar haemorrhage and/or after kidney biopsy. | Continue until circulating anti-GBM antibodies are no longer detectable; this is usually about 14 days. |
Suspected or confirmed anti-GBM glomerulonephritis with kidney salvage potential and/or alveolar haemorrhage. The KDIGO exception applies only when all conditions are met: dialysis dependence at presentation; an adequate biopsy showing either crescents in 100% of glomeruli or global glomerulosclerosis in more than 50% of glomeruli; and no pulmonary haemorrhage.
- Role
- Start without delay as part of combined therapy with glucocorticoids and cyclophosphamide; TPE is not stand-alone treatment.
- Exchange dose and course
- Exchange 40–50 mL/kg ideal body weight daily.
- Replacement fluid
- 5% albumin; add fresh frozen plasma at the end of exchange for alveolar haemorrhage and/or after kidney biopsy.
- Endpoint
- Continue until circulating anti-GBM antibodies are no longer detectable; this is usually about 14 days.
| Disease presentation | Role | Exchange dose and course | Replacement fluid | Endpoint |
|---|---|---|---|---|
| Symptomatic hyperviscosity, mainly Waldenström macroglobulinaemia, or planned IgM reduction before rituximab. | Category I bridge while definitive cytoreductive therapy takes effect; it does not replace cytoreduction. | One to three exchanges of 1.0–1.5 calculated plasma volumes initially, weekly to twice weekly. | 4.5% or 5% human albumin solution. | Stop the bridge when cytoreduction takes effect or the pre-rituximab IgM goal is reached. In chemotherapy-refractory disease, maintenance frequency is guided by symptoms and plasma viscosity. |
Symptomatic hyperviscosity, mainly Waldenström macroglobulinaemia, or planned IgM reduction before rituximab.
- Role
- Category I bridge while definitive cytoreductive therapy takes effect; it does not replace cytoreduction.
- Exchange dose and course
- One to three exchanges of 1.0–1.5 calculated plasma volumes initially, weekly to twice weekly.
- Replacement fluid
- 4.5% or 5% human albumin solution.
- Endpoint
- Stop the bridge when cytoreduction takes effect or the pre-rituximab IgM goal is reached. In chemotherapy-refractory disease, maintenance frequency is guided by symptoms and plasma viscosity.
Replacement-fluid prescription
| Strategy | When it fits | Main trade-off | Prescription and monitoring check |
|---|---|---|---|
| Human albumin solution | Generally preferred for non-TTP indications when the exchange need not replace a missing plasma component; the cited BSH regimens use 4.5% or 5% albumin. | Lower allergic and transfusion risk than plasma, but does not replace coagulation factors or immunoglobulins; repeated exchanges can reduce fibrinogen. | Write the concentration and volume, then follow bleeding, coagulation tests, fibrinogen, and cumulative course effects. |
| Plasma | Use when the indication requires a plasma component, as in iTTP, or when haemostatic replacement is required by the disease or bleeding context. | Replaces plasma proteins but increases citrate exposure, donor exposure, and allergic, anaphylactoid, and transfusion-reaction risk. | Specify the plasma product and compatibility pathway; monitor reaction symptoms, ionized calcium, balance, and haemostasis. |
| Albumin plus plasma | Use only when an indication or bleeding-risk plan calls for partial factor replacement, such as recent biopsy or pulmonary haemorrhage. | Can limit plasma exposure while supporting haemostasis, but the composition and sequence must be explicit rather than an assumed ratio. | Write each component and volume, intended sequence, total replacement, net balance, and fibrinogen or bleeding endpoint. |
Human albumin solution
- When it fits
- Generally preferred for non-TTP indications when the exchange need not replace a missing plasma component; the cited BSH regimens use 4.5% or 5% albumin.
- Main trade-off
- Lower allergic and transfusion risk than plasma, but does not replace coagulation factors or immunoglobulins; repeated exchanges can reduce fibrinogen.
- Prescription and monitoring check
- Write the concentration and volume, then follow bleeding, coagulation tests, fibrinogen, and cumulative course effects.
Plasma
- When it fits
- Use when the indication requires a plasma component, as in iTTP, or when haemostatic replacement is required by the disease or bleeding context.
- Main trade-off
- Replaces plasma proteins but increases citrate exposure, donor exposure, and allergic, anaphylactoid, and transfusion-reaction risk.
- Prescription and monitoring check
- Specify the plasma product and compatibility pathway; monitor reaction symptoms, ionized calcium, balance, and haemostasis.
Albumin plus plasma
- When it fits
- Use only when an indication or bleeding-risk plan calls for partial factor replacement, such as recent biopsy or pulmonary haemorrhage.
- Main trade-off
- Can limit plasma exposure while supporting haemostasis, but the composition and sequence must be explicit rather than an assumed ratio.
- Prescription and monitoring check
- Write each component and volume, intended sequence, total replacement, net balance, and fibrinogen or bleeding endpoint.
Review angiotensin-converting enzyme inhibitor exposure before every session. When possible, the BSH guideline recommends withholding it for 24–72 hours before TPE using fresh frozen plasma; if flushing, abdominal symptoms, dyspnoea, or hypotension develops, pause the exchange and assess an allergic/anaphylactoid or bradykinin-mediated reaction.
Technique, vascular access, and extracorporeal volume
The clinical prescription—target plasma removed, replacement composition, net balance, course, and endpoint—does not change with the separation method. Choose the method that can deliver it safely with local expertise.
Centrifugal TPE
Often accommodates reliable peripheral access and commonly uses citrate anticoagulation. Confirm that inlet and return access remain stable and that the planned replacement and citrate exposure are tolerable.
Membrane TPE
Usually needs dialysis-quality central access and may use heparin or citrate according to the platform and patient. Plan around filter performance, circuit pressures, anticoagulation, and the prescribed plasma removal and replacement.
Choose the least invasive access that reliably supports the selected method and full course. Examine for infection, bleeding, thrombosis, malposition, recirculation, and dysfunction before each session; do not assume a peripherally inserted central catheter can meet circuit demands.
Compare extracorporeal circuit volume with patient blood volume and haemodynamic reserve, especially in a small adult, anaemia, shock, or any child outside this guide’s scope. Agree priming, warming, and connection strategy with the apheresis team and installed-platform instructions before connection.
Anticoagulation and calcium plan
- Choose by method and patient
State the anticoagulant strategy after reviewing separation method, installed device, access, platelet/coagulation status, active bleeding, thrombosis risk, liver and kidney function, and concurrent anticoagulants. There is no universal citrate ratio or heparin dose.
- If citrate is used or plasma is infused
Account for citrate from both anticoagulant and replacement plasma. Monitor symptoms, rhythm when clinically indicated, ionized calcium, magnesium, acid–base status, and the greater accumulation risk with impaired citrate metabolism.
- If heparin is used
Account for systemic bleeding risk, circuit losses of heparin and antithrombin, and the effect of TPE on interpretation of coagulation or anti-Xa results. Use the method-specific local protocol rather than a copied generic bolus or infusion.
- Write prevention and rescue before starting
Define symptom surveillance, ionized-calcium sampling, and oral or intravenous calcium response according to severity and local protocol. For paraesthesia, tetany, QT prolongation, or arrhythmia, pause or reduce citrate exposure as the platform permits, assess promptly, treat, and reassess before continuing.
Baseline, procedural, and course monitoring
- Before each session
Reconfirm indication, endpoint, weight/haematocrit used for volume, haemodynamic reserve, access, fluid balance, replacement, anticoagulation, calcium plan, and medicines. Obtain CBC, platelet count, coagulation tests including fibrinogen, ionized calcium, magnesium, and potassium; obtain ABO/Rh and an antibody screen when plasma or red-cell priming may be needed.
- During exchange
Keep a trained clinician in attendance with resuscitation capability. Trend blood pressure, heart rate, oxygenation, temperature and symptoms; observe access, circuit pressures, anticoagulant exposure, replacement delivered, net balance, and signs of hypocalcaemia, reaction, bleeding, haemolysis, air, or clotting.
- After each session
Record actual plasma removed, replacement delivered, net balance, interruption, blood return, access status, and adverse events. Repeat CBC, coagulation/fibrinogen, electrolytes and ionized calcium according to replacement, symptoms, bleeding risk, and cumulative course; time samples knowing TPE alters many biomarkers.
- Before ordering the next session
Measure the disease-specific endpoint named in the prescription, review rebound and new production of the target substance, reconcile medicines, and decide explicitly to continue, modify, delay, or stop.
Complications: recognize, pause, treat, reassess
| Event | Immediate sequence |
|---|---|
| Hypotension or shock | Pause exchange; assess airway, breathing and circulation; verify patient position, access, net balance and replacement delivery; look for bleeding, sepsis, cardiac failure, or reaction; treat the cause and resume only after stability and prescription review. |
| Citrate symptoms or hypocalcaemia | Pause or reduce citrate exposure as the platform permits; check symptoms, ECG/rhythm and ionized calcium with magnesium; give calcium through the local severity-based pathway; reassess before restarting. |
| Allergic, anaphylactoid, or transfusion reaction | Stop the implicated replacement product; assess airway, breathing and circulation; treat anaphylaxis or the transfusion reaction immediately; retain product details and samples required by policy; do not restart that product without specialist authorization. |
| Suspected haemolysis or blood leak | Stop the procedure and follow the active platform blood-leak pathway; inspect circuit and effluent, assess the patient, and obtain haemolysis testing. Do not decide to return circuit contents until the cause and platform instructions have been reviewed. |
| Bleeding, low fibrinogen, or thrombosis | Pause when clinically required; examine patient and access, repeat haemostatic tests, review albumin/plasma exposure and anticoagulation, treat the event, and revise replacement, interval, or access before another exchange. |
| Air alarm, circuit breach, or clotting | Stop or isolate the circuit as the active platform directs; assess the patient and every connection; never bypass a safety alarm. Decide on blood return, set change, and restart only through the platform workflow and clinical review. |
| Access bleeding, dysfunction, infection, or thrombosis | Stop using an unsafe access; control bleeding and assess patency, position, infection and thrombosis; obtain alternate access only when its benefit exceeds insertion and course risks. |
Hypotension or shock
- Immediate sequence
- Pause exchange; assess airway, breathing and circulation; verify patient position, access, net balance and replacement delivery; look for bleeding, sepsis, cardiac failure, or reaction; treat the cause and resume only after stability and prescription review.
Citrate symptoms or hypocalcaemia
- Immediate sequence
- Pause or reduce citrate exposure as the platform permits; check symptoms, ECG/rhythm and ionized calcium with magnesium; give calcium through the local severity-based pathway; reassess before restarting.
Allergic, anaphylactoid, or transfusion reaction
- Immediate sequence
- Stop the implicated replacement product; assess airway, breathing and circulation; treat anaphylaxis or the transfusion reaction immediately; retain product details and samples required by policy; do not restart that product without specialist authorization.
Suspected haemolysis or blood leak
- Immediate sequence
- Stop the procedure and follow the active platform blood-leak pathway; inspect circuit and effluent, assess the patient, and obtain haemolysis testing. Do not decide to return circuit contents until the cause and platform instructions have been reviewed.
Bleeding, low fibrinogen, or thrombosis
- Immediate sequence
- Pause when clinically required; examine patient and access, repeat haemostatic tests, review albumin/plasma exposure and anticoagulation, treat the event, and revise replacement, interval, or access before another exchange.
Air alarm, circuit breach, or clotting
- Immediate sequence
- Stop or isolate the circuit as the active platform directs; assess the patient and every connection; never bypass a safety alarm. Decide on blood return, set change, and restart only through the platform workflow and clinical review.
Access bleeding, dysfunction, infection, or thrombosis
- Immediate sequence
- Stop using an unsafe access; control bleeding and assess patency, position, infection and thrombosis; obtain alternate access only when its benefit exceeds insertion and course risks.
Medication and biologic timing
Before the course, pharmacy and the treating team identify drugs likely to be removed: high protein binding, low volume of distribution, recent intravascular dosing, continuous infusion, narrow therapeutic index, immunoglobulins, and monoclonal antibodies.
Give intravenous medicines after the session when clinically possible. Do not delay time-critical therapy; instead agree drug-specific sampling, dose replacement, or alternative timing from primary pharmacokinetic evidence.
Schedule immunoglobulins and biologics after an exchange and maximize the protocol-supported interval before the next session. Avoid a universal redosing interval because removal and redistribution are drug- and course-specific.
Use therapeutic drug monitoring when available, particularly during serial TPE and for narrow-index antimicrobials, anticoagulants, and immunosuppressants; interpret samples in relation to exchange and post-exchange redistribution.
Record the time of the last and next exchange beside every affected dose, infusion, assay, and biologic plan, then hand the schedule to pharmacy, nursing, apheresis, and the disease team.
Translate the completed prescription to the device
Only after the clinical order is complete, map it to the installed system with a trained operator. A device-calculated value or default is not the indication, exchange dose, fluid choice, anticoagulation prescription, or endpoint.
Spectra Optia
Verify current sex, height, weight, haematocrit and total blood volume; map the prescribed multiple and volume to Plasma volumes exchanged and Plasma removed; select the prescribed replacement-fluid type and patient fluid balance; cross-check Replace volume: Target and the run summary against the written order.
PrisMax / Prismaflex
Map haematocrit and the prescribed exchange/replacement volume to the TPE prescription; keep total plasma exchanged and replacement delivered distinct from Patient Plasma Loss, which represents net plasma loss/fluid balance. Cross-check treatment history and cumulative volumes against the written order.
Clinical and circuit troubleshooting
| Finding | Sequence |
|---|---|
| New instability or symptoms | Pause exchange → assess airway, breathing and circulation → identify hypovolaemia, citrate effect, reaction, bleeding, sepsis or cardiac cause → treat → recheck the prescription before any restart. |
| Access or return-pressure alarm | Pause as directed → inspect clamps, kinks, connections and patient position → assess aspiration/return and access position without forcing flow → correct the cause or change access → resume through the platform alarm workflow. |
| Rising membrane pressure or circuit clotting | Pause as directed → inspect filter, circuit and access → review delivered anticoagulation and bleeding risk → do not override limits → change/end the set through the platform workflow and rewrite the next-session plan. |
| Air or blood-leak alarm | Stop or isolate the circuit as directed → assess the patient → inspect connections, return line, detector segment, effluent and filter → follow the installed-system safety pathway → decide on blood return and restart only after cause review. |
| Replacement or balance discrepancy | Pause → verify fluid identity, bags/containers, weights, connections and displayed cumulative volumes → compare with patient examination and the written net-balance target → reconcile before continuing. |
| Procedure interrupted or ended early | Stabilize the patient → record actual plasma removed, replacement delivered, net balance and whether circuit blood returned → reassess the indication endpoint → the disease/apheresis specialist decides whether and when to complete the planned course. |
New instability or symptoms
- Sequence
- Pause exchange → assess airway, breathing and circulation → identify hypovolaemia, citrate effect, reaction, bleeding, sepsis or cardiac cause → treat → recheck the prescription before any restart.
Access or return-pressure alarm
- Sequence
- Pause as directed → inspect clamps, kinks, connections and patient position → assess aspiration/return and access position without forcing flow → correct the cause or change access → resume through the platform alarm workflow.
Rising membrane pressure or circuit clotting
- Sequence
- Pause as directed → inspect filter, circuit and access → review delivered anticoagulation and bleeding risk → do not override limits → change/end the set through the platform workflow and rewrite the next-session plan.
Air or blood-leak alarm
- Sequence
- Stop or isolate the circuit as directed → assess the patient → inspect connections, return line, detector segment, effluent and filter → follow the installed-system safety pathway → decide on blood return and restart only after cause review.
Replacement or balance discrepancy
- Sequence
- Pause → verify fluid identity, bags/containers, weights, connections and displayed cumulative volumes → compare with patient examination and the written net-balance target → reconcile before continuing.
Procedure interrupted or ended early
- Sequence
- Stabilize the patient → record actual plasma removed, replacement delivered, net balance and whether circuit blood returned → reassess the indication endpoint → the disease/apheresis specialist decides whether and when to complete the planned course.
Sources
1. Primary source
Guidelines on the Use of Therapeutic Apheresis in Clinical Practice — Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue
American Society for Apheresis · 2023
Accessed Aug 1, 2026
2. Primary source
Apheresis procedures for the treatment of patients and for the collection of cellular therapy products: A British Society for Haematology guideline
British Society for Haematology · First published 2025-07-15
Accessed Aug 1, 2026
3. Supporting source
Plasma exchange in the intensive care unit: a narrative review
Bauer et al. · Online 2022-08-12; print 2022-10
Accessed Aug 1, 2026
4. Supporting source
Therapeutic Plasma Exchange Using Membrane Plasma Separation
Ahmed and Kaplan · Online 2020-04-20; print 2020-09
Accessed Aug 1, 2026
5. Primary source
Prediction of blood volume in normal human adults
Nadler et al. · Surgery 1962;51:224–232
Accessed Aug 1, 2026
6. Primary source
ISTH guidelines for treatment of thrombotic thrombocytopenic purpura
International Society on Thrombosis and Haemostasis · J Thromb Haemost 2020;18:2496–2502
Accessed Aug 1, 2026
7. Primary source
International consensus guidance for management of myasthenia gravis: Executive summary
Myasthenia Gravis Foundation of America · Neurology 2016;87:419–425
Accessed Aug 1, 2026
8. Primary source
KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases, Chapter 11 update
Kidney Disease: Improving Global Outcomes · Chapter updates posted 2024-05
Accessed Aug 1, 2026
9. Supporting source
Spectra Optia Apheresis System Operator’s Manual
Terumo Blood and Cell Technologies · PN 1000036875; revision 2023-08; release 2024-08-15
Accessed Aug 1, 2026
10. Supporting source
PrisMax System Operator’s Manual
Baxter · AW8035 Rev B; June 2019; program 2.xx
Accessed Aug 1, 2026
11. Supporting source
Prismaflex System Operator’s Manual
Gambro Lundia AB · G5039912; program 7.xx; ©2005–2015
Accessed Aug 1, 2026