Is there any indication for plasmapheresis in pregnancy?
Plasmapheresis can be safely performed during pregnancy, and introduction of plasmapheresis for specific indications has improved maternal and fetal survival rates. Plasmapheresis has been safely carried out in myasthenic crisis, Guillain-Barré syndrome, anti-GBM disease, acute fatty liver of pregnancy, and TTP. There is no indication in cardiac neonatal lupus, despite its theoretical benefits.
Some complications of plasmapheresis are premature delivery due to the removal of essential hormones maintaining pregnancy, hypovolemic reaction, allergy, transitory cardiac arrhythmias, and nausea. During the exchanges, blood pressure must be carefully monitored to avoid hypotension, and after the second trimester, it is preferable to place the patient on her left side to avoid compression of the inferior vena cava by the gravid uterus.