What is apheresis / plasmapheresis  

What is it?

Blood consists of four components: red cells, white cells, platelets, and plasma. Plasma is the water between the blood cells. Apheresis is a process in which one or more blood components are removed from the blood, while the remaining components are returned to the patient.

There are different forms of apheresis possible, including:

• Plasmapheresis; the replacement or purification of plasma. Used for the treatment of high cholesterol and autoimmune diseases, among other things.^1,2,3
• Leukopheresis; the removal of white blood cells. Used to treat leukemia.⁴
• Hemapheresis; the removal and replacement of red blood cells in cases of, for example, sickle cell anemia.⁴

Different forms of plasmapheresis

When we think about post-COVID, we often talk about plasmapheresis. Plasmapheresis is a treatment method in which blood is temporarily separated outside the body into blood cells and plasma. Using a special device, substances can be selectively removed from the plasma. The purified plasma is then returned to the body along with the blood cells. Sometimes an alternative such as donor plasma or artificial plasma is chosen. Plasmapheresis is also offered by private clinics, sometimes under other names such as Biopheresis or INUSpheresis.

Various forms of plasmapheresis are possible. Specific plasmapheresis, for example, can remove only (specific) antibodies, also known as immunoadsorption. Broader-spectrum techniques can also remove other substances such as proteins, lipoproteins, and harmful substances. The exact substances removed depend on the chosen apheresis technique.

What is known about the effect on post-COVID?

There are several hypotheses about the persistent post-COVID symptoms (fatigue, brain fog, shortness of breath, etc.) that have multiple possible causes. Such as:

1. autoantibodies that attack the body;
2. a high presence of inflammatory substances;
3. the formation of microclots in the blood.

Plasmapheresis could theoretically be a treatment for removing these factors. Therefore, it is currently being investigated ^5,6,7,8.

To research*

Several (small) studies in ME/CFS show a promising result in lowering autoantibodies after plasmapheresis, with a positive effect on psychological well-being⁹ and improvements in clinical symptoms such as fatigue ¹⁰.

In post-COVID patients, clinical improvement was found after two cycles of Heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) apheresis¹²HELP apheresis is a technique that removes viral particles, fibrinogen, cytokines, and microclots, among other things. This technique can improve blood flow and oxygen supply to organs.¹¹.

Other plasmapheresis studies in which autoantibodies, cytokines, toxins and immune complexes were extracted from plasma in long-term (>2 years) and severely disabled post-COVID patients showed no improvement in fatigue, quality of life, neurocognitive complaints and other reported symptoms.^{13, 14}

summarizing

Several studies show that plasmapheresis is a safe treatment. There are no serious side effects, only local discomfort at the injection site and gastrointestinal complaints. However, various studies show that some participants discontinue treatment prematurely due to increased fatigue.

The difference in effect and lack of effect may be due to participant selection. Inflammatory marker concentrations between patients at the beginning of the disease process and more than two years post-COVID can differ.¹³In addition, there were some differences, but not significant ones, among subgroups of patients who participated. Further research will therefore be needed to determine which subgroup of post-COVID patients benefits from plasmapheresis treatment.

*Unfortunately, there is no literature available on what this intervention could mean for complaints after COVID-19 vaccination and QVS.

 

Sources

1. https://www.c-support.nu/duitse-behandelingen-bc-007-en-help-aferese/?mark=aferese
2. C. Boedecker, et al. 2021. Immunoadsorption and plasma exchange-Efficient treatment options for neurological autoimmune diseases. J Clin Apher
3. Stummvoll, et al. 2017. Immunoadsorption in Autoimmune Diseases Affecting the kidney. Seminars in nephrology.
4. Sanquin's Special Collection Team | Sanquin
5. Steenblok, et al. 2022. Post-COVID and Apharesis – where are we standing? Horm Metab Res.
6. E. Davis, et al. 2023. Long COVID: major findings, mechanisms and recommendations. Nature
7. Fox, et al. 2023. Plasmapheresis to remove amyloid fibrin(ogen) particles for treating the post-COVID-19 condition.
8. H. Preßler, et al. 2024. IA-PACS-CFS: a double-blinded, randomized, sham-controlled, exploratory trial of immunoadsorption in patients with chronic fatigue syndrome (CFS) including patients with post-acute COVID-19 CFS (PACS-CFS). Trials.
9. Oesch-Régeni, et al. 2025. The Effect on Quality of Life of Therapeutic Plasmapheresis and Intravenous Immunoglobulins on a Population of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients with Elevated β-Adrenergic and M3-Muscarinic Receptor Antibodies-A Pilot Study. J Clin Med
10. Markus Tölle, et al. 2020. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Efficacy of Repeat Immunoadsorption. J Clin Med
11. R. Jaeger, et al. 2022. The potential of heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP)-apheresis for patients with severe acute or chronic COVID-19. Front Cardiovasc Med.
12. M. Achleitner, et al. 2023. Clinical improvement of Long-COVID is associated with reduction in autoantibodies, lipids, and inflammation following therapeutic apheresis. Mole Psy
13. E. Stein, et al. 2025. Efficacy of repeated immunoadsorption in patients with post-COVID myalgic encephalomyelitis/chronic fatigue syndrome and elevated β2-adrenergic receptor autoantibodies: a prospective cohort study. Lancet.
14. S. España-Cueto, et al. 2025. Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial. Nat Commun.