TPE is one of the most established treatments in apheresis medicine — recognized as first-line therapy for multiple autoimmune conditions by the American Society for Apheresis.
In autoimmune disease, the immune system generates autoantibodies that attack the body's own tissues. These pathogenic antibodies circulate in the blood, continuously reaching their targets. Inflammatory cytokines and immune complexes amplify the damage, creating a self-perpetuating cycle of tissue injury.
A single full plasma volume exchange removes approximately 60–70% of circulating autoantibodies, immune complexes, complement factors, and inflammatory cytokines. This rapidly reduces the concentration of disease-driving molecules, interrupting the cycle of immune-mediated tissue destruction.
5% albumin replacement fluid is immunologically neutral — it contains no autoantibodies or inflammatory mediators. Beyond providing essential oncotic support, albumin has well-documented anti-inflammatory and antioxidant properties that support immune rebalancing during the recovery period.
TPE works alongside immunosuppressives, corticosteroids, and biologics. Those medications may take days to weeks for full effect; TPE provides immediate reduction in pathogenic molecules — particularly valuable during acute flares, rapid clinical deterioration, or as a bridge to longer-term immunotherapy.
The American Society for Apheresis (ASFA) categorizes indications for therapeutic apheresis into four categories based on the strength of available evidence. Category I designates conditions for which TPE is a first-line treatment. Category II designates well-established second-line or supportive therapy.
Many Category I conditions present as medical emergencies that are initially treated in hospital settings. Our outpatient practice focuses on:
If your condition is emergent or urgent, please call 911 or go to your nearest emergency room.
Anti-acetylcholine receptor antibodies disrupt signaling at the neuromuscular junction, causing fatigable muscle weakness that can progress to respiratory failure. TPE rapidly reduces pathogenic antibody concentrations and is recognized as ASFA Category I for moderate-to-severe MG and myasthenic crisis.
An acute autoimmune attack on the peripheral nervous system that causes ascending weakness and potential paralysis. TPE is a first-line treatment alongside IVIG, with the greatest benefit demonstrated when initiated early in the disease course. ASFA Category I.
The chronic counterpart to GBS, CIDP involves ongoing immune-mediated demyelination of peripheral nerves. TPE removes the circulating antibodies and immune complexes that drive progressive nerve damage. ASFA Category I.
Anti-aquaporin-4 antibodies target astrocytes in the optic nerves and spinal cord, causing severe attacks of optic neuritis and transverse myelitis. TPE is ASFA Category I for acute attacks, rapidly clearing the pathogenic antibodies that drive tissue destruction.
Antibodies against NMDA receptors in the brain produce a distinctive syndrome of psychiatric symptoms, seizures, movement disorders, and autonomic instability. TPE removes these antibodies from circulation. ASFA Category I.
Autoantibodies against ADAMTS13 — a critical enzyme for von Willebrand factor processing — cause widespread microvascular thrombosis. TPE is the definitive treatment: it removes the inhibitory autoantibodies while replacing the deficient enzyme. ASFA Category I.
For severe MS relapses refractory to high-dose corticosteroids, TPE removes inflammatory mediators and demyelinating antibodies. ASFA Category II for steroid-refractory attacks.
In severe lupus — including lupus nephritis — TPE reduces circulating immune complexes, anti-dsDNA antibodies, and complement-activating factors. ASFA Category II for severe manifestations.
Progressive fibrosis of the skin and internal organs driven by autoantibody-mediated vascular injury and immune activation. TPE removes the pathogenic antibodies and profibrotic mediators. ASFA Category II.
TPE is recognized for numerous additional autoimmune conditions — including autoimmune hemolytic anemia, pemphigus vulgaris, and vasculitis. ASFA categorizes over 80 conditions for which therapeutic apheresis may be appropriate. Our physicians evaluate each patient's clinical situation individually.
Our physicians bring decades of specialized training in therapeutic apheresis. Dr. Kiprov — a founding member of the American Society for Apheresis — has over 40 years of experience treating autoimmune conditions and has overseen more than 15,000 apheresis procedures throughout his career. Dr. Green's fellowship training at UT Southwestern Medical Center under Dr. Ravi Sarode provided deep hands-on experience across the full spectrum of autoimmune indications.
Our physicians' published research includes: optimizing caplacizumab dosing in immune-mediated TTP (Yates, Green, Sarode et al., Blood Vessels, Thrombosis & Hemostasis, 2024), TPE response in systemic sclerosis (ASFA 2023 poster presentation), and TPE in hyperviscosity syndrome associated with juvenile rheumatoid arthritis (Green et al., Journal of Clinical Apheresis, 2021).
Together, our physicians have contributed to over 100 peer-reviewed publications in apheresis medicine.
A typical acute course consists of 5–7 TPE sessions over 1–2 weeks. Treatment is coordinated with your neurologist, rheumatologist, or referring specialist and is appropriate once emergency stabilization is complete.
For conditions like CIDP and refractory myasthenia gravis, periodic maintenance TPE sessions help sustain clinical improvement. Frequency is tailored to each patient's clinical response and adjusted over time.
TPE is most effective as part of a coordinated treatment plan. Our physicians work alongside your existing specialists — neurologists, rheumatologists, hematologists — adding apheresis expertise to your care team, not replacing your specialist.
We offer flexible scheduling for patients traveling from outside the Bay Area to our Mill Valley clinic. Contact us to coordinate a treatment schedule that accommodates your travel arrangements.
Schedule a free discovery call with our physicians to discuss whether therapeutic plasma exchange is appropriate for your autoimmune condition.
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