Ischemic Stroke After Plasmapheresis

Plasmapheresis involves the separation of all cellular elements of blood with the help of an extracorporeal semipermeable membrane. Even though plasmapheresis is generally considered safe, there have been anecdotal reports of thrombosis related to this exchange. We present 2 cases of healthy young males developing ischemic strokes within 24 hours of plasmapheresis. Patient A was a 24-year-old man with a family history of Factor V Leiden mutation presented with right-sided weakness 1 hour after donating plasma. A hypercoagulable work-up revealed elevations in Factor II. Patient B was a 42-year-old man who presented with a right facial droop, expressive aphasia and right arm weakness. He had donated plasma 18 hours before his presentation. A hypercoagulable work-up revealed elevated levels of von Willebrand factor antigen and high sensitivity C-reactive protein. A procoagulant state induced by plasmapheresis likely increases the risk for symptomatic thrombosis when an underlying thrombophilic state is present in the donor.