When infections trigger lasting immune dysregulation, TPE removes the circulating autoantibodies and inflammatory factors that perpetuate symptoms — addressing the disease where conventional treatments cannot reach.
Infections can trigger persistent immune dysregulation that continues long after the original pathogen has been cleared. In conditions like PANS/PANDAS, Long COVID, and post-viral chronic fatigue, the immune system produces autoantibodies and inflammatory mediators that circulate in the plasma, attacking the body's own tissues and driving debilitating symptoms.
The mechanisms vary by condition but share a common thread: the initial infection provokes an immune response that fails to resolve. In PANS/PANDAS, molecular mimicry leads to autoantibodies that cross-react with brain tissue. In Long COVID, persistent inflammation, endothelial damage, and microclot formation create a self-sustaining cycle of immune activation. In post-viral fatigue syndromes, circulating immune complexes and cytokine dysregulation perpetuate exhaustion and cognitive impairment.
Conventional treatments — antibiotics, anti-inflammatories, immunosuppressants — address part of the problem but cannot physically remove the pathogenic autoantibodies and inflammatory factors already circulating in the blood. Therapeutic plasma exchange can. By removing and replacing the plasma, TPE eliminates circulating autoantibodies, pro-inflammatory cytokines, complement proteins, immune complexes, and microclot-promoting factors — providing the immune system an opportunity to recalibrate.
TPE physically removes the pathogenic autoantibodies that drive tissue damage in PANS/PANDAS and contribute to immune dysregulation in Long COVID and post-viral fatigue. A single procedure removes approximately 60–70% of circulating antibodies.
Elevated IL-6, TNF-α, IL-1β, complement proteins, and other pro-inflammatory cytokines sustain the immune activation cycle. TPE removes these factors and replaces them with albumin, which has inherent anti-inflammatory and antioxidant properties.
In Long COVID, circulating factors promote microclot formation and endothelial dysfunction. TPE removes fibrinogen, von Willebrand factor, and other coagulation-related proteins that contribute to the microvascular pathology increasingly recognized in post-COVID syndromes.
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) occur when an infection — most commonly streptococcal — triggers the production of autoantibodies that cross-react with basal ganglia tissue in the brain. This molecular mimicry drives acute-onset neuropsychiatric symptoms: obsessive-compulsive behaviors, tics, severe anxiety, emotional lability, cognitive regression, sleep disruption, and behavioral changes that can be profoundly disabling.
TPE removes the circulating autoantibodies, immune complexes, and inflammatory cytokines that sustain the neuropsychiatric attack. By reducing the concentration of these pathogenic factors, TPE can support symptom improvement and create a window for the immune system to rebalance. Treatment response varies significantly between patients — some experience meaningful improvement over the course of treatment, while others require multiple rounds or combination therapy with immunomodulatory agents. Our physicians work closely with each patient’s neurologist or psychiatrist to coordinate care.
PANS/PANDAS is recognized in the ASFA guidelines. Published case series and clinical experience support the use of TPE in moderate-to-severe presentations, particularly when conventional immunotherapy has been insufficient. The PANS/PANDAS Research Consortium at Stanford has included plasma exchange among recommended immunomodulatory treatments for moderate-to-severe cases.
Long COVID is characterized by persistent symptoms lasting weeks to months after acute SARS-CoV-2 infection: fatigue, cognitive impairment (“brain fog”), autonomic dysfunction, exercise intolerance, headaches, and joint pain. Multiple mechanisms have been identified, including persistent autoantibodies, chronic inflammation with elevated cytokines, endothelial dysfunction, and microclot formation. These pathogenic factors circulate in the plasma, sustaining symptoms long after the virus has been cleared.
TPE removes the autoantibodies, inflammatory cytokines, complement proteins, and microclot-promoting factors that perpetuate Long COVID symptoms. By replacing the pathogenic plasma with albumin — which has anti-inflammatory and antioxidant properties — TPE addresses the circulating component of the disease that conventional treatments cannot reach. Dr. Kiprov published among the first clinical data on TPE for Long COVID, and our practice has treated numerous patients with this condition.
Dr. Kiprov’s early clinical reports on TPE for post-COVID syndromes are among the first published in the literature. Subsequent case series from multiple centers have supported the use of therapeutic apheresis in Long COVID patients, particularly those with elevated inflammatory markers and autoantibody panels. Research into specific biomarkers that predict TPE response in Long COVID is ongoing.
Chronic fatigue and immune dysregulation following viral infections are not unique to COVID-19. Epstein-Barr virus (EBV), influenza, enteroviruses, and other pathogens can trigger persistent immune activation that continues long after the initial infection resolves. Patients experience debilitating fatigue, cognitive difficulties, unrefreshing sleep, post-exertional malaise, and a constellation of symptoms that overlap with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
In post-viral fatigue syndromes, circulating inflammatory mediators, autoantibodies, and immune complexes perpetuate the cycle of immune dysregulation and symptom persistence. TPE removes these factors from the blood, providing an opportunity for immune recalibration. Our physicians evaluate each patient’s clinical picture, inflammatory markers, and autoantibody profiles to determine whether TPE is appropriate and to develop an individualized treatment approach.
The evidence base for TPE in post-viral fatigue is evolving. Clinical experience and emerging case reports suggest benefit in patients with identifiable circulating immune abnormalities. The mechanistic rationale is consistent with the established role of TPE in other autoantibody-mediated and inflammatory conditions.
Important: Post-infectious syndromes are complex conditions with variable presentations. Not every patient is a candidate for TPE, and treatment response cannot be guaranteed. Our physicians conduct a thorough evaluation before recommending treatment and set realistic expectations based on the available evidence and each patient's specific clinical picture.
Our physicians conduct a thorough evaluation including clinical history, symptom characterization, relevant laboratory work (autoantibody panels, inflammatory markers, complement levels), and review of prior treatments. For PANS/PANDAS patients, we coordinate with the referring neurologist or psychiatrist. For Long COVID patients, we assess the specific symptom profile and inflammatory burden to determine candidacy.
Treatment protocols vary by condition and individual presentation. A typical initial course involves a series of TPE sessions — generally 3–7 procedures over a condensed period. The specific number of sessions, frequency, and replacement fluid composition are tailored to each patient’s clinical needs. PANS/PANDAS, Long COVID, and post-viral fatigue may each require different approaches.
Post-infectious syndromes are complex, multisystem conditions. Our physicians work alongside your existing care team — neurologists, psychiatrists, immunologists, infectious disease specialists, and primary care physicians. TPE is most effective as part of a coordinated treatment plan that may include immunomodulatory medications, antimicrobial therapy, and supportive care.
After the initial treatment course, our physicians track symptom response and laboratory markers to assess benefit and determine whether additional sessions are warranted. Some patients achieve sustained improvement after an initial series, while others benefit from periodic maintenance sessions. Treatment decisions are guided by objective data and clinical response.
For patients traveling to our Mill Valley clinic from outside the Bay Area, flexible scheduling can be arranged to accommodate logistics. Contact our office to discuss treatment planning for out-of-area patients.
Treatment response varies significantly between conditions and between individual patients. Some Long COVID patients report improvement in fatigue and cognitive symptoms within weeks of starting treatment. PANS/PANDAS response is less predictable — some patients improve over the course of treatment while others require multiple rounds or combination therapy. Our physicians set realistic expectations during the consultation and track objective markers alongside symptom improvement.
TPE has been used in pediatric PANS/PANDAS patients, and our physicians have experience treating both pediatric and adult patients with this condition. Candidacy depends on the severity of symptoms, response to prior treatments, and the ability to tolerate the procedure. We work closely with the referring pediatric neurologist or psychiatrist to ensure coordinated care. Parental involvement and support are essential throughout the treatment process.
Yes. While PANS/PANDAS was originally described in children, it is increasingly recognized in adolescents and adults. The underlying mechanism — infection-triggered autoantibodies attacking brain tissue — can occur at any age. Our physicians evaluate adult patients presenting with acute-onset neuropsychiatric symptoms consistent with PANS.
Insurance coverage for TPE in post-infectious conditions varies by carrier, plan, and specific diagnosis. Some PANS/PANDAS cases may be covered under autoimmune or neurological indications. Long COVID coverage is evolving as clinical evidence accumulates. Our administrative staff works with patients and insurers to submit prior authorization requests and can provide the clinical documentation needed for coverage decisions.
Many patients who come to us for post-infectious syndromes have not responded adequately to conventional treatments — antibiotics, anti-inflammatories, immunosuppressants, or symptom management approaches. TPE addresses the disease from a different mechanism: directly removing the circulating pathogenic factors that sustain symptoms. It is not uncommon for patients to experience benefit from TPE after other approaches have been insufficient. Our physicians will review your treatment history during the consultation.
Yes. TPE is frequently used alongside other immunomodulatory therapies. For PANS/PANDAS, this may include corticosteroids, IVIG, or rituximab. For Long COVID, complementary approaches may include anti-inflammatory protocols and targeted symptom management. Our physicians coordinate with your existing care team to ensure that TPE is integrated effectively into your overall treatment plan.
If you or a family member is living with a post-infectious syndrome and conventional treatments have not provided adequate relief, a complimentary discovery call can help determine whether TPE may be appropriate.
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