1. Plasma Exchange consists of the removal of large volumes of the patient' s plasma and replacing it with exogenous plasma or plasma substitutes Action: removes from the circulation any pathogenic material decrease T lymphocytes (indirect action) normalize abnormal T4/T8 ratio (indirect)

2. In 10 Pxs with PG treated with plasma exchange once to three times weekly for a total of 4 to 27 exchanges - (7) excellent response - (3) incomplete or no response

3. Potential complications include: a.vasovagal reactions b.hypovolemia or fluid c.overload, d.electrolyte abnormalities e.infection of indwelling lines, f.bleeding tendency caused by depletion of platelets or clotting factors, In Px given plasma as replacement fluid: a.allergic reactions b.transfusion-related infections (hepatitis, HIV) c.difficulty in gaining vascular access, d.lesions can develop at venipuncture sites.

4. Human intravenous immune globulin (IVIG) Therapy human IVIG, 0.4 gm/kg per day, for 5 days effective in one patient with PGP after failure to respond to prednisone, dapsone, cyclosporine,and pulse methylprednisolone while therapy with cyclosporine and prednisone was continued. * When used at the higher doses, IVIG possesses immunosuppressive activity through poorly understood mechanisms.

5. The principal disadvantages of this treatment a.high cost b.adverse effects (headache, chills, fever) c.potential for transmission of diseases with pooled sera.