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The American Society for Apheresis lists Plasma Exchange as an accepted 1st-line therapy, either alone or with other treatment for a PANDAS exacerbation.

The full ASFA guidelines, as established in the 2013 Journal of Clinical Apheresis, appeared in their ‘Special Issue’ that is published every 3 years. The guidelines can be found at: Guidelines on the Use of Therapeutic Apheresis in Clinical Practice—Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Sixth Special Issue.

Merck Manual on Therapeutic Apheresis also lists Plasma Exchange as a first line therapy at


In this process the harmful auto-antibodies are removed from the blood system itself. This procedure is done in a hospital setting. Please read about the procedure here.

The success rate for this procedure is equally very good. There are not many providers that offer Plasmapheresis for PANDAS and PANS, but those that do have cited seeing symptoms improve even while the procedure is till occurring. When a child is presenting with very severe symptoms that would be considered “life threatening”, Plasmapheresis may be the preferred method of treatment due to the quick response rate. An example of a life threatening symptoms would be severe restricted food intake with significant weight loss and suicidal thoughts.

What is not clear is if the child’s autoimmune system will recreate the negative antibodies. It has been reported that PEX has had to be repeated (as with IVIG) in a few cases. Again, prophylactic antibiotics should be maintained.




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