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Experience with large volume plasmapheresis in malignant paraproteinaemia and immune disorders.

Clinical experience with large volume plasmapheresis in a wide range of malignant and immune disorders is described. An average of 4 litres of plasma was exchanged for various colloid and electrolyte solutions. Patient tolerance was good but close medical and nursing supervision in monitoring fluid balance and adverse reactions to replacement fluids is necessary. Plasmapheresis has been established to be of benefit in immunoproliferative diseases when complicated by hyperviscosity, and may also have a place in other cases with haemostatic or renal impairment. Autoantibodies, alloantibodies and immune complexes can be removed by plasmapheresis, but the effect is usually transient and the procedure should be combined with immunosuppressive therapy in most cases. The removal of blocking factors in disseminated malignant melanoma is an experimental procedure at present, but initial results have been encouraging.