Therapeutic Plasma Exchange

THE acceptance of the Renaissance concept that an illness could be helped by bloodletting was tempered by the adverse effects of blood loss. Indeed, Louis XIII and George Washington were probably killed by this therapy.^{1 , 2} The selective removal of plasma (plasmapheresis) was first carried out early in this century by Fleig³ and Abel et al.,⁴ but there was little enthusiasm for its clinical use, because the manual removal of large amounts of plasma was cumbersome and time-consuming. In 1960 Schwab and Fahey reported that plasmapheresis is unquestionably beneficial to patients with Waldenström's macroglobulinemia and manifestations of hyperviscosity⁵; manual plasmapheresis . . .