[Which patients should be treated with plasma exchange? Indications for plasma exchange therapy]

What is the current opinion on therapeutic plasma exchange, after 20 years of clinical use for numerous patients and disease states? Principles of rational therapy have broken through into the field of therapeutic plasmapheresis during the last decade. Efficacy proven by controlled clinical trials is the prerequisite for determining indications. Superiority of plasma exchange over other therapeutic modalities has been established for only a limited number of rare diseases. Plasma exchange treatment is still actual for plasmatic hyperviscosity syndromes in the course of haematological and rheumatological diseases. Indications for therapeutic plasma exchange in nephrology are narrowed to some forms of Goodpasture's syndrome, rapidly progressive glomerulonephritis with antineutrophil cytoplasmic antibodies and renal insufficiency, and thrombotic thrombocytopenic purpura/haemolytic uraemic syndrome. Plasma exchange therapy is indicated for severe forms of Guillain-Barré syndrome and myasthenia gravis. Therapeutic benefit of plasma exchange was not found by controlled clinical trials in patients with rheumatoid arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, multiple sclerosis and rejection of kidney allotransplant.