Use of plasmapheresis and partial plasma exchange in the management of patients with cryoglobulinemia.

The management of patients with cryoglobulins often meets with limited success. Reported here is the use of plasmapheresis and/or partial plasma exchange in the management of five patients with cryoglobulinemia. The procedure was carried out at room temperature with reinfusion through a blood warmer. Circulating levels of mixed cryoglobulins and monoclonal IgM cryoglobulins were more easily reduced than were IgG cryoproteins. Improvement in symptoms was associated with removal of the cryoprotein. Pheresis can be used as primary therapy for reduction of cryoglobulin levels in cases of symptomatic essential cryoglobulinemia. Where an etiology for cryoglobulinemia is known and specific treatment exists, pheresis can be used as effective adjunct therapy.