Therapeutic plasma exchange, or TPE, is a hospital-based procedure that removes a portion of your plasma and replaces it with a prescribed replacement fluid, which may include albumin or donor plasma.
TPE is an established medical procedure performed in hospitals and specialist healthcare settings worldwide, including at Monash House Private Hospital’s outpatient Infusion Unit, where it is delivered using dedicated apheresis equipment. Treatment is provided by trained and experienced nursing staff with specialised training in therapeutic plasma exchange (TPE).
How TPE works
TPE is a form of apheresis, a process that separates specific components of blood for therapeutic purposes.
Plasma is a straw-coloured liquid that carries many important substances throughout the body, including antibodies, clotting factors, hormones and proteins. In some immune-mediated conditions, certain antibodies or other proteins in the plasma may contribute to disease activity.
Removing and replacing the plasma can temporarily reduce the amount of those substances circulating in the bloodstream, helping to reduce disease activity or symptoms in some patients. While it can significantly reduce the level of circulating antibodies, it’s not permanent – your body continues to produce new antibodies over time.
During TPE treatment:
- Whilst lying in the hospital bed, the treatment team establishes suitable vascular access, often through IV lines in the arms.
- Blood from one arm flows into the apheresis machine.
- The apheresis machine separates the plasma from other blood components and removes the plasma.
- The remaining blood components flow out of the apheresis machine and into the other arm, along with the prescribed replacement fluid.
The replacement fluid is selected to suit your clinical needs and does not contain the disease-related antibodies or proteins that have been removed during the exchange. Depending on the replacement fluid used, some proteins such as clotting factors and immunoglobulins may also be removed during treatment. For this reason, your treatment team carefully considers the balance of risks and benefits, and monitors your blood results throughout the treatment.
When TPE may be considered
TPE is used for specific conditions in which harmful substances circulating in plasma are known, or strongly suspected, to contribute to disease. It’s often paired with other treatments aimed at the underlying disease itself.
As TPE works by removing and replacing plasma, it may be considered in conditions in which harmful antibodies, proteins, toxins or other circulating substances are thought to contribute to disease. The decision to use TPE is made by the treating specialist based on the patient’s diagnosis, symptoms and overall treatment plan.
Is TPE a one-off treatment?
TPE is usually delivered as a series of treatments over several days, with the schedule set by the treating doctor.
This is due to TPE removing substances already circulating in the plasma but doesn’t stop the body from producing them. Levels can begin to rise again after treatment, so repeated exchanges may be needed depending on the condition and response.
Receiving TPE at Monash House
TPE treatment at Monash House takes place in our outpatient Infusion Unit. Treatment duration varies depending on the individual and clinical indication, but many procedures take approximately 2 hours. Most patients spend the time reading, listening to music or resting in bed.
TPE is not usually painful, though there may be some discomfort or bruising from inserting the IV lines.
Like all medical treatments, TPE can cause side effects. These may include temporary changes in blood pressure, reactions to the medications used during treatment, fluid shifts, or effects from the plasma proteins being removed and replaced. Most side effects are temporary and resolve with treatment or observation.
Our clinical team monitors you closely throughout and before discharge. Once you get home, it’s wise to drink plenty of fluids and take it easy for the rest of the day.
Learn more about TPE at Monash House ┃Refer a patient for TPE
Frequently asked questions about TPE
Is TPE the same as dialysis?
No. TPE and dialysis both involve blood passing through a machine outside the body, but they’re not the same. Dialysis is used when your kidneys can’t adequately clear waste, electrolytes and excess fluid. In contrast, TPE removes plasma itself, along with substances dissolved within it, and replaces it with another fluid.
What does plasma do?
Plasma is the liquid component of blood. It carries blood cells and transports important substances around the body, including antibodies, clotting factors, proteins, hormones and nutrients. It also helps maintain blood volume and supports the body’s immune and clotting functions. In regard to TPE, plasma is important because it can also carry antibodies or abnormal proteins that contribute to certain diseases.
Does TPE remove all antibodies?
No. TPE lowers the level of antibodies circulating in the plasma at the time of treatment, but it does not prevent the body from making new antibodies. As levels can increase again, some conditions may require repeated treatments.
Will I need more than one TPE treatment?
Probably. Some conditions need only a short course; others require repeated exchanges. Your treating doctor determines the schedule.
Can I go home afterwards?
Yes, TPE takes approximately 2 hours and you head home once the clinical team is satisfied you’re medically stable.
How do I know whether TPE is relevant to my condition?
Talk to your treating specialist or GP. TPE requires a referral and medical assessment, and whether it’s suitable depends on your diagnosis, medical history and treatment plan. Monash House Private Hospital also welcomes enquiries from healthcare practitioners about referral pathways.
Disclaimer
All information is general and not intended as a substitute for professional advice.
References
- Connelly-Smith, L., Alquist, C. R., Aqui, N. A., et al. (2023). 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. Journal of Clinical Apheresis, 38(2), 77–278. https://doi.org/10.1002/jca.22043
- Pais, M. D., Gaspar, A., & Coelho, S. (2026). Therapeutic Plasma Exchange—A Practical Guide. Kidney and Dialysis, 6(1), 8. https://doi.org/10.3390/kidneydial6010008
- Australian Red Cross Lifeblood. (2025). Clinical Practice. Retrieved September 2026, from Clinical Practice | Australian Red Cross Lifeblood.
