ENPlasmapheresis in Germany is prescribed not as a tonic but to remove harmful substances from the blood quickly: the body’s own antibodies, excess proteins and immune complexes that will not clear by themselves. So it almost always accompanies the main treatment rather than replacing it.
Below: how it works, where it genuinely helps, how a session and a course go, how you may feel, and what it does not do. It is most often used for nervous system diseases, collected in the neurology section.
What happens during the procedure
A machine separates the plasma, the liquid part of the blood, from the cells and replaces it. Blood runs through a tube into the machine, where a centrifuge or membrane filter does the separation; the cells return to the patient with a replacement fluid, usually albumin solution, sometimes donor plasma.
Two related methods are often confused with it. Immunoadsorption does not discard the plasma but passes it through a column that takes out only the antibodies; lipoprotein apheresis lowers cholesterol in inherited metabolic disorders. The doctor chooses the method; for the patient the main difference is what replaces the plasma, and these two need no replacement.
Plasmapheresis is not dialysis. Dialysis removes small substances and water when the kidneys fail; plasmapheresis removes large molecules and antibodies. If you need kidney replacement, see dialysis in Germany.
When it is genuinely prescribed
It is prescribed where its benefit is proven; most indications are in neurology: a myasthenic crisis, a dangerous weakness of the breathing muscles, and preparation for surgery in myasthenia gravis; Guillain-Barré syndrome, an acute nerve inflammation; chronic inflammatory polyneuropathy; a severe multiple sclerosis relapse when steroids have not worked; and neuromyelitis optica spectrum disorders, which inflame the optic nerves and spinal cord. See myasthenia gravis treatment and multiple sclerosis treatment.
In haematology and nephrology the indications are thrombotic thrombocytopenic purpura, where clots form in small vessels, platelets drop and plasma exchange counts as emergency treatment; anti-glomerular basement membrane (Goodpasture) disease; severe vasculitis affecting the kidneys and lungs; and organ transplantation, before surgery and in rejection. See vasculitis treatment and blood diseases.
A board of doctors decides, following international and German guidelines: what counts is proven benefit in this condition at this severity, not simply «raised values» in a test. The German Society of Nephrology’s standard for therapeutic apheresis (in German, revised in 2025) grades indications from first-line treatment to conditions where it does not help or even harms.
What plasmapheresis does not do
Plasmapheresis is not a «cleansing of the blood» from toxins, nor a remedy for tiredness, a rejuvenation procedure or a treatment for allergy, psoriasis or chronic pain «in general». A German hospital will not prescribe it «as prevention», and an offer of a course «to cleanse the body» marks the wrong clinic.
The mechanism matters too: the body makes the removed antibodies again. So plasmapheresis is almost always combined with drugs that stop them being made, such as steroids or immunosuppressants. Without them the effect is short-lived, as patients are honestly told before the course.
How a session and a whole course go
A course is a series of sessions, each connecting the patient to the machine through the veins. With good veins two peripheral lines, one in each arm, are enough. Otherwise a central catheter, a thin tube placed under local anaesthetic in a large neck or groin vein, gives the machine a steady, sufficient blood flow.
During a session the patient lies down, the machine runs, and a nurse and a doctor watch blood pressure, pulse and wellbeing. The doctor sets the length of a session, the number of sessions and the intervals. Patients can usually read or talk and are observed for a while afterwards.
Around the course, blood is tested before and after sessions, including calcium and clotting values. Medicine timing is agreed in advance: some drugs are washed out with the plasma, so they are taken after a session, not before. See the general page on treatment of blood diseases in Germany.
Risks and how they are reduced
The risks are well known: blood pressure can drop, causing weakness, and citrate, which stops blood clotting in the machine, binds calcium, causing tingling around the mouth and fingers. Allergy to the replacement fluid or donor plasma is possible. After several sessions clotting factors and immunoglobulins, the antibodies that fight infection, fall, and a catheter can become infected or cause thrombosis.
Risks are reduced by a gradual start, laboratory checks between sessions and a department equipped for emergencies. The catheter is carefully looked after, and fever, shivering, a rash or pain at the catheter site must be reported at once. After the course the doctor explains the restrictions for the next few days.
Frequently asked questions
Does plasmapheresis hurt?
It is almost painless; only the start is unpleasant, when needles go into the veins or a central catheter is placed under local anaesthetic. Tingling around the mouth and fingers, feeling cold, weakness or dizziness can occur: tell the nurse at once, as these are usually eased quickly and settle after the procedure.
Do I need to stay in hospital?
It depends on the disease and its severity. A myasthenic crisis, a severe relapse or thrombotic thrombocytopenic purpura is treated in hospital, often in intensive care. In a stable condition sessions are sometimes outpatient, with the patient staying nearby. The doctor decides after reviewing the documents.
How much does plasmapheresis cost in Germany?
The hospital gives the sum in a written estimate after reviewing the documents. It depends on the diagnosis, the number of sessions and tests, whether a central catheter is needed and whether treatment is inpatient, in intensive care or outpatient. If sessions are added later, the sum changes too.
How AlenMed arranges plasmapheresis
AlenMed sends discharge letters, recent results and disease reports, plus nervous system test results for a neurological diagnosis, to the relevant department of a German hospital. The doctor answers whether plasmapheresis is indicated or further tests come first, and how long a course will take. Then come a written estimate, a visa invitation, the appointment and back-to-back sessions, and an interpreter.
A course stretches over days or weeks, so plan accommodation near the hospital and someone to come along, and agree in advance who will follow the patient at home and how the further treatment plan reaches the doctor there.
This material is for information only and is not an offer. The indication for plasmapheresis and the treatment plan are decided by a doctor at an in-person consultation.