Question
A friend of mine, who has a very debilitating neurological disease, has been receiving a treatment called plasma exchange in a London hospital. This removed harmful antibodies from his blood.
My understanding is that people with ME also have these harmful antibodies. Is this a treatment that we ought to be looking into?
Answer
As you correctly point out, plasma exchange is sometimes used in specialist hospitals to treat autoimmune neurological diseases by removing harmful antibodies called autoantibodies.
Plasma is the fluid portion of the blood that allows the circulation of red blood cells, white blood cells, and platelets. The main constituent is water in which numerous compounds are dissolved. Plasma also allows chemical communication between different parts of the body to occur by carrying proteins, minerals, hormones, vitamins, and antibodies – both beneficial and harmful .
Plasma exchange involves the separation and removal of the plasma from the blood in order to remove abnormal substances like autoantibodies. The red blood cells, white blood cells, and platelets are returned to the patient, along with a prescribed replacement fluid such as Human Albumin Solution or fresh frozen plasma. Simply stated, the “old plasma” is removed and replaced by the “new plasma.”
Unfortunately, while there is evidence that plasma exchange can be helpful in treating some types of autoimmune diseases, there is no evidence from any clinical trials to indicate that it is a safe and effective treatment for ME/CFS. This is probably due to the fact that, while some people with ME/CFS have low levels of these autoantibodies, they don’t appear to have a significant role in the actual disease process.
Many years ago, when I was working with neurologist Professor Peter Behan at the Institute for Neurological Sciences in Glasgow, we assessed the use of plasma exchange in a small number of people with well-defined ME/CFS (myself included) with no obvious benefit.
While this is not a treatment for ME/CFS that is recommended by NICE in our current state of knowledge, it is a form of treatment that may be worthy of further research in people who have autoantibodies.
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We recommend that the medical information is discussed with your doctor. It is not intended to be a substitute for personalised medical advice or treatment. You should consult your doctor whenever a new symptom arises, or an existing symptom worsens. It is important to obtain medical advice that considers other causes and possible treatments. Do not assume that new or worsened symptoms are solely because of ME/CFS or Long Covid.