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Immunomodulation Replacement Treatments
Immunoglobulin (IV or SC)
This treatment is routinely used for people whose MG is rapidly worsening. Immune globulin, or immunoglobulin, is a form of human blood that has been carefully screened, then combined from several donors. By giving the body a number of normal antibodies from donated blood, the treatment temporarily balances the immune system. Improvements often appear within a week of treatment and last for several months. You may notice your MG weakness getting better and find that you are able to do more daily activities with less discomfort.
Plasmapheresis
Plasmapheresis is a method for removing blood from the body. It is sometimes known as 'plasma exchange' and is typically prescribed for people with worsening or severe MG.
During treatment, plasma is removed from the blood and replaced with a plasma substitute before the blood is returned to the body. The process is designed to remove antibodies – both bad and good – from the blood. It can work as an effective therapy for MG and is often the first treatment choice for many patients, particularly those suffering a myasthenic crisis.
Your medical professional will start by inserting a needle into a vein in each arm. When the needles are secure, blood is withdrawn and taken away from the body into a machine. Here, the blood is separated to allow for easy removal of the plasma and antibodies. Next, the remaining parts of the blood – the red cells, white cells and other components – are combined with sterile blood substitutes (albumin) to replace some of the proteins lost in the procedure. The fluid is returned through the other arm.
The whole procedure takes between one to three hours. In most cases, you will be offered an outpatient appointment at a hospital or infusion centre. It is recommended that you rest for a short period of time once the treatment is complete, and it is a good idea to have a family member or friend accompany you home afterwards as you may feel tired.
Plasmapheresis is not considered painful and there are few side effects. Some people report a tingling or numbness in the fingertips or lips – this is because of the fluid that is added during the treatment to prevent blood from clotting while it is inside the machine. Tingling or numbness is usually brief and passes quickly. You may notice a slight bruising or swelling where the needle was inserted. If you suffer any discomfort or associated side effects, tell your healthcare provider immediately.
Typically, it takes three to five treatments before patients experience any noticeable improvement. Your healthcare provider will help to explain the number of procedures they find necessary for your specific case. Some people with MG will use the treatment on a consecutive daily basis, while others may decide to use it every other day. Your healthcare provider will individualise your treatment, so you can be sure you are receiving the right frequency for your needs.