An approach to immunologic reactions associated with plasma exchange.

Immunologically mediated anaphylactic-type events are not uncommon with PE. The pathogenesis of these reactions is not well understood and demands further investigation. If a technique or equipment-related phenomenon can be identified, it should be addressed (e.g., replace the membrane for a more biocompatible membrane and use better rinsing procedures to eliminate ethylene oxide). Testing for specific relevant immunogen, either by in vivo or in vitro methods, if these methods are available, should be considered. If infusion of essential blood products is the most likely cause, then a premedication regimen may be helpful in preventing such reactions. As the risks and benefits of treatment are weighed, it is important to remember that every hive need not be eliminated. Instead, the goal is to prevent compromise to oxygenation and perfusion in both mother and fetus while comfort is maintained and drug-induced adverse effects are avoided.