STAGES ONE AND TWO
DISCUSSION, THEN CONSULTATION
STAGES THREE AND FOUR
ASSESSMENT, THEN REFERRAL
A TREATMENT GIVEN ON CLINICAL INDICATION
Therapeutic plasma exchange removes the liquid part of your blood, the plasma, and replaces it with a purified protein solution, albumin, while your blood cells are returned to you. It is used to remove antibodies, proteins and other substances in the plasma that are driving a particular illness. At Reborne it is a hospital procedure, prescribed only after a consultant has assessed you and found a condition for which the evidence supports it.
We do not offer plasma exchange as a treatment for healthy ageing. Our consultant neurologist assesses patients with neurological conditions where plasma exchange may help, and refers for treatment where it is indicated. We also treat selected immune-mediated conditions and very high lipoprotein(a) on specialist referral.
It happens in four stages: a discussion, a consultation, an assessment, and a referral for treatment where the evidence and the assessment support it. Each stage is set out below. The first step is to request an initial screening consultation by WhatsApp on +44 7951 254 181, using the button on this page; nothing is booked with a specialist until that screening has taken place. Members and non-members are seen on the same clinical basis.
STAGE ONE
The Discussion
It begins with an initial screening consultation, which you request by sending us a WhatsApp message on +44 7951 254 181 using the button below. Our physician and membership team then speak with you, by telephone, by video or at the townhouse. You tell us what concerns you and what you have been told so far; we tell you plainly whether plasma exchange is a treatment we would consider for that concern, and for what. If the concern is healthy ageing, inflammation or biological age, we say at this stage that plasma exchange is not a treatment we offer for it, and we talk about what we can do instead. No appointment with a specialist is made until this screening has taken place.
STAGE TWO
The Consultation
You see the consultant whose specialty covers your condition: our consultant neurologist for neurological and cognitive conditions, a cardiologist for very high lipoprotein(a), the relevant specialist for an immune-mediated disease. The consultant takes your history, reviews your results and the medicines you take, and tells you where your condition sits in the American Society for Apheresis guidelines, which grade the evidence for plasma exchange in each illness. The consultation is not a commitment to treatment, and where the evidence does not support it the consultant says so.
STAGE THREE
The Assessment
If the consultant considers plasma exchange may help, we assess whether it is safe for you. That means an examination of your heart and circulation; blood tests covering blood count, kidney and liver function, clotting, calcium and albumin; an infection screen; a review of every medicine you take, because some blood pressure medicines interact with the procedure; and an assessment of your veins, which in older patients can be the limiting factor. Age, frailty and some conditions raise the risks, and the assessment is where we find that out. If the risks outweigh the likely benefit, we say so and we stop.
STAGE FOUR
The Referral
Where the consultant finds a condition the evidence supports and the assessment shows the procedure is safe for you, they refer you for treatment and set the number and timing of sessions. For each condition we start from the guidelines of the American Society for Apheresis (Tenth Special Issue, Journal of Clinical Apheresis, September 2026), which grade the strength of the evidence for plasma exchange in each illness. These are the conditions we treat, with the evidence for each.
Plasma exchange has its longest record in neurology. It is a first-line or established treatment in several antibody-driven conditions, including Guillain-Barré syndrome, myasthenia gravis in crisis, chronic inflammatory demyelinating polyneuropathy and neuromyelitis optica spectrum disorder, and is used in some acute relapses of inflammatory demyelinating disease that do not respond to steroids. Our consultant neurologist assesses whether your condition is one where the evidence supports it and, if so, sets the number and timing of sessions.
Evidence
American Society for Apheresis, Guidelines on the Use of Therapeutic Apheresis in Clinical Practice, Tenth Special Issue, Journal of Clinical Apheresis, 2026.
In autoimmune conditions, the immune system mistakenly produces proteins called autoantibodies that attack the body's own tissues. These circulate in the blood and can cause significant and progressive damage over time. Plasma exchange can rapidly reduce the levels of these harmful immune proteins, offering meaningful relief where other treatments may be slow or insufficient.
This is one of the most established uses of plasma exchange. The American Society for Apheresis guidelines recognise it as a first-line or adjunctive therapy for a range of antibody-driven conditions, including myasthenia gravis, Guillain-Barré syndrome, neuromyelitis optica and selected complications of lupus. The evidence spans multiple randomised controlled trials and Cochrane reviews going back decades. We treat these conditions on specialist referral.
Evidence
American Society for Apheresis, Guidelines on the Use of Therapeutic Apheresis in Clinical Practice, Tenth Special Issue, Journal of Clinical Apheresis, 2026.
One of the hallmarks of Alzheimer's disease is the accumulation of a protein called amyloid in the brain. Research shows that amyloid in the brain and amyloid in the bloodstream are in balance with each other. By reducing amyloid levels in the blood through plasma exchange, it may be possible to encourage the brain to offload some of its own amyloid burden, a concept known as the peripheral sink effect.
The AMBAR trial, published in Alzheimer's and Dementia in 2020, tested plasma exchange with albumin replacement in people with mild to moderate Alzheimer's disease and reported a slower decline in some measures of daily function in the moderate group. It is one trial, and Alzheimer's disease is not yet an established indication for plasma exchange.
At Reborne it is considered only on an individual basis, after a full neurological assessment by our consultant neurologist. It is not presented as a cure, but as a clinically supervised treatment with a limited and still developing evidence base, and we explain that plainly before anything is agreed.
Evidence
Boada M et al., Alzheimer's and Dementia, 2020 (the AMBAR trial); Sagare AP et al., Nature Reviews Neurology, 2012; American Society for Apheresis, Tenth Special Issue, 2026.
Lipoprotein(a), or Lp(a), is a type of cholesterol particle that significantly raises the risk of heart attack and stroke. Unlike standard cholesterol, Lp(a) is largely determined by your genes, meaning diet, exercise and most medications have very little effect on it.
For people with very high Lp(a) levels who are at serious cardiovascular risk despite optimised treatment, lipoprotein apheresis is one of the few interventions available that can produce meaningful reductions. Published apheresis literature consistently reports acute Lp(a) reductions of 60 to 75% per session in selected patients. We provide this treatment on referral from a cardiologist, after a full review of your cardiovascular profile including genetic lipid testing.
Evidence
Apheresis techniques can significantly reduce circulating Lp(a) in selected patients. Key references: Moriarty PM et al., Journal of Clinical Lipidology, 2019; Tsimikas S, Journal of the American College of Cardiology, 2017; American Society for Apheresis, Tenth Special Issue, 2026.
A less widely known but clinically supported application of TPE is the removal of protein-bound environmental toxins, heavy metals, and other large-molecular-weight substances that the body struggles to clear naturally through the liver and kidneys alone.
Many environmental toxins, including heavy metals such as lead and mercury, mycotoxins from mould exposure, and certain persistent environmental chemicals, bind to plasma proteins when they circulate in the bloodstream. Because standard detoxification pathways rely on the liver and kidneys breaking substances down, they are often poorly equipped to clear these protein-bound compounds efficiently. TPE takes a different approach: by physically removing the plasma itself, it can directly extract these bound toxins along with the plasma that carries them.
Heavy metals: Clinical reports have documented measurable reductions in circulating heavy metals including lead and mercury following TPE, particularly in cases of documented accumulation where conventional detoxification support has been inadequate.
Mycotoxins: TPE has been used in cases of significant mould-related illness to reduce circulating mycotoxins, which can have both neurotoxic and immune-suppressive effects.
Environmental chemicals: Emerging clinical data supports the use of TPE in cases of high environmental pollutant burden including organophosphates and persistent organic compounds.
In selected cases, Reborne may also use a more targeted technique called Double Filtration Plasmapheresis (DFPP), which employs a second specialised filter to selectively extract particular substances while returning more of the beneficial plasma proteins to the patient. This approach offers greater precision when a specific toxin or antibody fraction is the primary target.
A note on evidence and eligibility
Toxin removal via TPE is supported by case reports, registry data, and mechanistic studies rather than large randomised trials. At Reborne, this pathway is offered within a carefully governed clinical framework, with full transparency about the current state of evidence. A comprehensive diagnostic workup, including validated laboratory testing for heavy metals and relevant toxin panels, is required before any treatment is recommended. All treatments are individually prescribed by our clinical team.
IF TREATMENT IS RECOMMENDED
The Procedure
A small amount of blood is drawn from a vein and passed through an apheresis machine, which separates your plasma from your blood cells. The plasma is removed and replaced with albumin, a purified human protein solution, and your blood cells are returned to you during the same procedure. We do not use donor plasma.
Each session takes between 90 minutes and 3 hours in a private treatment room, monitored throughout by our clinical team. Most patients find it similar to a long infusion, and it is normal to feel tired for a day or so afterwards. The number and spacing of sessions are set by the consultant for your condition; no course has been validated for healthy ageing, and we do not offer one.
To find out whether plasma exchange may apply to you, send us a WhatsApp message on +44 7951 254 181 to request an initial screening consultation. That screening comes first; an appointment with a specialist follows only if the screening supports it.