#100- Dr. Carley Squires discusses Therapeutic Plasma Exchange (TPE)

In this episode of the Neuroveda Podcast for Complex Health, Gillian Ehrlich, ARNP, sits down with Dr. Carley Squires to discuss apheresis, with a focus on therapeutic plasma exchange (TPE), also known as plasmapheresis.

Apheresis means the removal of something from the blood, and the type of apheresis depends on what is being removed. At Neuroveda, the focus is plasma apheresis, meaning plasma is removed and replaced with albumin and saline. Therapeutic plasma exchange is an extracorporeal blood purification technique designed to remove a portion of plasma that may contain potentially harmful substances such as autoantibodies, inflammatory cytokines, immune complexes, and other immune mediators involved in immune dysregulation.

Dr. Squires explains the broader umbrella of therapeutic apheresis, including red blood cell exchange, leukapheresis, plateletpheresis, lipid/LDL apheresis, extracorporeal photopheresis, and H.E.L.P. apheresis. While H.E.L.P. apheresis is not currently available in the United States, interest in apheresis expanded during the rise of long COVID, when patients began traveling internationally for treatment.

Therapeutic plasma exchange has been used for decades in hospital settings, primarily for autoimmune disease, but is now being explored for additional applications including long COVID, neuroinflammatory conditions, and longevity medicine. Research suggests TPE may help support immune modulation through mechanisms such as:

• Removal of immune complexes
• Reduction of inflammatory cytokines
• Correction of altered Th1/Th2 immune balance
• Increased T regulatory and T suppressor cells

Emerging research has also explored TPE for PANDAS/PANS, pediatric autoimmune neuropsychiatric disorders triggered by infection.

References
https://www.sciencedirect.com/science/article/pii/S0149763417305833
https://pubmed.ncbi.nlm.nih.gov/10513708/

While additional research is still needed for many of these applications, Neuroveda has also observed significant clinical improvements over the past several years, including reductions in toxic burden from mycotoxins, heavy metals, solvents, plastics, and other persistent environmental toxins.

The episode also reviews current American Society for Apheresis (ASFA) guidance, which places many emerging uses of apheresis into Category III, meaning the optimal role is still being defined and treatment decisions should be individualized.

Reference
Connelly-Smith L, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice. J Clin Apher. 2023.

Listeners will also hear what to expect from a TPE treatment at Neuroveda. Each session lasts approximately 2–4 hours, during which blood circulates through a machine that separates and removes plasma while returning the remaining blood components with replacement fluid.

Although the procedure may sound invasive, TPE is generally well tolerated and safely performed in outpatient settings. Vital signs are monitored throughout treatment, and most patients experience only mild side effects such as fatigue, lightheadedness, or temporary electrolyte shifts.

One unique aspect of Neuroveda’s approach is the integration of Ayurvedic medicine with modern therapeutic plasma exchange. Ayurvedic therapies use oils, massage, steam, and other treatments to mobilize lipophilic toxins from deeper tissues back into circulation. Because TPE removes substances circulating in the bloodstream, these therapies may help prepare the body for detoxification.

This aligns with Panchakarma, Ayurveda’s classical detoxification process, which includes rakta moksha, traditionally translated as “blood liberation.” In a modern context, TPE can be viewed as a technological evolution of this ancient concept.

Rather than functioning as a stand-alone cure, TPE is often most effective as part of a comprehensive program that may include functional medicine, regenerative medicine,