Quick answer
Plasmapheresis, or plasma exchange, is a procedure that removes part of the plasma from your blood and replaces it with albumin. Your cells go back into your body. It is not the same as donating plasma. In hospitals, it is proven for about 90 diseases. For longevity, the evidence is still early.
The essentials
- It is a medical procedure with decades of use in hospitals, for specific diseases.
- For longevity it is experimental: the best trial (42 healthy adults) measured biological clocks, not health or years of life.
- It is not a “total cleanse”, a detox or “young blood”.
- At Monarka, a session lasts between 60 and 100 minutes and albumin is used as the replacement.
- It has risks and contraindications: first, a doctor assesses your case.
You may have seen Bryan Johnson talk about swapping his plasma. Or someone may have told you that plasmapheresis “renews your blood”. It sounds promising, and it is normal to want to know if it is true.
The answer has two parts. In hospitals it works and has been known for decades. For living longer or aging better, the studies are still small. Here we explain what it is, what it really shows, and when we do not recommend it.
What is plasmapheresis?
The plasma is the liquid part of the blood, yellow in color. It carries proteins, antibodies and chemical signals. It makes up a little over half of your blood.
In plasmapheresis, a machine separates the plasma from your cells. It removes that plasma and replaces it with a solution, usually albumin (the most abundant protein in plasma). Then it returns your cells to you.
A simple way to picture it: it is like changing part of the water in an aquarium without taking the fish out. Be careful with the analogy: it is not a total cleanse or a magic detox. Your body makes its proteins again within a few days, so the effect is temporary.
Nor is all the plasma replaced. One exchange of one plasma volume removes, in theory, about 63% of a substance that circulates only in the plasma. The rest stays.
| Term | What it means |
|---|---|
| Apheresis | General name for the techniques that separate one component of the blood: plasma, platelets, cells… |
| Plasmapheresis | Removing plasma. In practice it is used to name the whole procedure. |
| Therapeutic plasma exchange | Removing the patient’s plasma and replacing it, for a medical purpose. |
| Plasma donation | A healthy person donates plasma for others. A smaller amount is taken and albumin is not replaced. |
| “Young plasma” | Infusion of plasma from young donors. It has no proven benefit and the FDA warned against it in 2019. |
Is it the same as donating plasma?
No. When you donate, a smaller amount of plasma is taken to be used in other patients. Your body replaces it on its own and no albumin is given.
In a therapeutic exchange, a much larger part of your own plasma is removed and replaced with albumin. The goal is different: in one case you help others, in the other the person having the procedure is treated.
What is a plasmapheresis session like? Does it hurt?
It is an outpatient procedure: you go, it is done and you go home the same day. These are the steps:
- Access. A line is placed in one vein to draw your blood and another to return it.
- Separation. A machine separates your cells from the plasma.
- Replacement. The plasma is removed and your cells go back in with albumin.
- Anticoagulant. Citrate is added so the blood does not clot in the circuit. It can cause tingling in the lips or fingers, because citrate binds calcium.
- Duration. At Monarka, between 60 and 100 minutes, with a maximum of about 2 hours. In hospitals, depending on the volume exchanged, it can last between one and three hours.
Does it hurt? The needle stick is like the one for a blood test. During the session you can read or rest. The most common things are feeling tingling or cold, and feeling tired afterwards. If you feel any discomfort, tell the team.
Before you come: it is best to be well hydrated and not to come fasting.
What is plasmapheresis for? What is proven
Plasmapheresis has been used in hospitals for decades. The ASFA (American Society for Apheresis) reviews its indications. Its 2023 guideline lists 91 diseases and 166 indications, sorted into four categories according to the strength of the evidence.
| Level | What is behind it |
|---|---|
| Solid | Autoimmune, neurological and blood diseases, treated in hospital (ASFA 2023 guideline). |
| Promising | Mild to moderate Alzheimer’s: the AMBAR trial (347 randomized patients). Mixed results; sponsored and supplied by an albumin manufacturer. |
| Early | Healthy aging: a trial of 42 adults (2025). It measures biological clocks, not health outcomes. |
| Not supported | “Young plasma” infusions. In 2019 the FDA warned that they have no proven benefit. |
| Category | Meaning | Examples |
|---|---|---|
| I | First-line, alone or with other treatments | Guillain-Barré syndrome, myasthenia gravis (acute treatment), thrombotic thrombocytopenic purpura, anti-glomerular basement membrane disease (with alveolar hemorrhage or without dialysis) |
| II | Second-line | Varies by disease |
| III | Role not established: individual decision | Varies by disease |
| IV | Ineffective or harmful | Varies by disease |
| No category | Healthy people, for longevity or wellness purposes | Experimental use, outside ASFA indications |
A 2026 analysis estimated that about a third of the 166 indications have a strong recommendation, and that only 8% rest on high-quality evidence.
Careful: being used in hospitals does not prove it helps you live longer. Healthy aging is not an ASFA indication.
Plasmapheresis and Alzheimer's: the AMBAR trial, carried out in Barcelona
The strongest study outside the classic indications was done here. The AMBAR trial (Grifols and Ace Alzheimer Center Barcelona) randomized 347 people with mild to moderate Alzheimer’s (322 received treatment and were analyzed). It had a sham-treatment group.
Patients received six weeks of weekly exchanges and then twelve months of monthly exchanges of lower volume, with albumin alone or with immunoglobulins (antibodies).
Pooling the treated groups, the decline in activities of daily living was 52% smaller than with placebo (p = 0.03). In cognition there was a trend, but it did not reach significance (p = 0.06). No treatment group reached significance on its own. The benefit was concentrated in moderate Alzheimer’s (61% less decline), a subgroup analysis to be taken with caution. In mild cases there were no differences on those two measures.
What is worth knowing
- It was sponsored and supplied by a company that makes albumin.
- One of the two main goals did not reach significance.
- The 61% comes from a subgroup.
- The authors themselves ask for more studies.
This trial does not show that plasmapheresis prevents or treats Alzheimer’s outside a research protocol.
Plasmapheresis and longevity: what the studies say
The idea has changed. Before, the aim was to “put in young blood”. Today the focus is on “diluting old blood”: removing signals that build up with age so tissues work better. It is a hypothesis. In people, the data are still small.
| Study | What it found | How strong it is |
|---|---|---|
| Mice, 2020 (Mehdipour, Aging) | Replacing half of the plasma of old mice with saline and albumin improved markers in muscle, liver and brain after a single exchange. Young blood was not needed. | Animals. It supports the hypothesis, but does not prove it in people. |
| Mice, 2022 (Jeon, Nature Metabolism) | Blood from old mice caused signs of cellular aging in young mice. | Animals. |
| People, 2022 (Kim, GeroScience) | Several rounds of exchange moved a biological-age marker based on blood proteins toward a younger profile. | Preliminary study. Markers only. |
| People, 2025 (Fuentealba, Aging Cell) | 44 healthy adults (most over 50) were enrolled and 42 completed the study. After four sessions, estimated epigenetic age was about 2.6 years lower with biweekly exchange plus immunoglobulins and about 1.3 years lower with monthly exchange, compared with placebo (average across several clocks). | Exploratory single-center trial, small. Several authors are linked to apheresis companies, and one of them performed the procedures. |
Three important limits:
- Epigenetic clocks are indirect markers, not measures of health.
- After the sixth session there were no longer significant differences from placebo.
- No study yet shows that people live longer or have fewer diseases.
What can you expect? Results vary from person to person. For longevity we cannot promise any: the evidence is preliminary.
And Bryan Johnson? What his case shows
Bryan Johnson is the best-known example. His path looks like the science:
- April 2023: he received plasma from his 17-year-old son, and his 70-year-old father received his plasma (according to Fortune).
- July 2023: he stopped after six monthly exchanges of 1 liter (only one with his son’s plasma). He said he noticed no added benefit on top of his regimen.
- January 2025: he announced he was moving to exchanges with 5% albumin and intravenous immunoglobulins, instead of young plasma.
The lesson: “young plasma” and exchange with albumin are not the same thing. The FDA warning from 2019 refers to plasma from young donors, not to albumin.
And his case proves nothing. He follows many other interventions at the same time.
What are the risks of plasmapheresis?
With albumin as the replacement, it is considered a low-risk procedure. The effects are usually mild and reversible. In a single-center series of 581 exchanges with 5% albumin (with calcium added), drops in blood pressure and citrate reactions happened in fewer than 5 in 100 sessions. And 3 in 100 were stopped early, half of them because venous access was lost.
| Effect | Why it happens | What is worth knowing |
|---|---|---|
| Tingling in lips, cramps | Citrate binds calcium | Tell the team. |
| Drop in blood pressure, dizziness | Fluid shifts | It is monitored throughout the session. |
| Bruise or vein problems | Needles or catheter | It is the most common practical nuisance. |
| Temporary drop in antibodies and clotting factors | They leave with the plasma | They recover. That is why some protocols add immunoglobulins. |
| Strong reaction with some drugs (ACE inhibitors) | Interaction with albumin | In a 1994 review, all 14 patients taking ACE inhibitors reacted (flushing or low blood pressure). Always tell your doctor. |
| Removal of drugs | Some are bound to plasma proteins | The doctor plans when to take your medication. |
Who should not have it?
These are situations in which the exchange may not be suitable or may call for extra caution:
- Unstable circulation, such as unstable heart disease.
- Severe infection or sepsis.
- Severe anemia or a clotting disorder. Low calcium or taking ACE inhibitors in the last 24 hours.
- Allergy to albumin or other replacement fluids, or no suitable venous access.
- Pregnancy (assessed case by case).
A doctor always decides, after assessing your case.
Is it for you?
It depends on the reason:
- If you have a disease with a recognized medical indication: your specialist decides, usually in a hospital.
- If you are a healthy person interested in longevity: it can be considered after a medical assessment, with clear information about the lack of evidence. If you would like to discuss your case, you can request a plasmapheresis assessment in Barcelona.
- If you are looking to “rejuvenate” or “detoxify” your blood: there is no proof of that effect. It is good to know this before you decide.
Before proposing anything, we review your blood tests and your history. Then we explain what you can expect and what you cannot. We assess with you whether it makes sense in your case.
At Monarka we do not see it as a stand-alone treatment. It can be part of a broader health plan, with other tools such as:
- Intravenous or oral supplementation, with vitamins, minerals and antioxidants.
- Hypoxia/hyperoxia therapy, a complementary treatment under research (see our article on IHHT).
- Genetic and epigenetic studies, which let us understand in depth how your body responds to its environment.
- Pain treatments, when there is an associated inflammatory or muscular basis.
- Advanced metabolic assessment, to optimize your energy and cellular health.
How much does plasmapheresis cost at Monarka?
At Monarka Clinic, the session costs €5,000, all included: the assessment with the specialist, blood tests if considered necessary and the full session. There are no hidden costs. It lasts between 60 and 100 minutes and the recommended schedule is one session a year, depending on the medical assessment.
In public healthcare, plasmapheresis is done in hospitals for recognized medical indications. Use for longevity or wellness purposes is not covered.
Prices vary a lot between centers, depending on the technique, the medical team and the tests included. To choose with confidence, ask:
- Which doctor is responsible and what experience they have.
- Whether the nursing staff is trained in apheresis.
- Which replacement fluid is used.
- Which tests are done beforehand and what the price includes.
- What the protocol is in an emergency.
- And be wary of any miracle promise.
You can see what the treatment is like and ask for information on our page about plasmapheresis in Barcelona.
Frequently asked questions about plasmapheresis
Is it the same as donating plasma?
No. When you donate, a smaller amount of plasma is taken for other patients, and albumin is not replaced. In a therapeutic exchange, a much larger part of your own plasma is removed and replaced with albumin, for a medical purpose.
Does it hurt? How long does a session last?
The needle stick is like the one for a blood test. You may notice tingling in the lips or cold, and tiredness afterwards. At Monarka, the session lasts between 60 and 100 minutes, with a maximum of about 2 hours.
How many sessions are needed?
It depends on the reason. For diseases, series of several sessions are usually done. Studies on aging also used several (for example, up to six in the 2025 trial, with different schedules). At Monarka, the recommended schedule is one session a year, depending on the medical assessment. There are no data showing that a single session produces the same changes as a series.
Do I lose defenses or antibodies?
Antibodies drop temporarily, because they leave with the plasma, and then recover. That is why some research protocols add immunoglobulins. Your doctor will explain what is done in your case.
Does it rejuvenate? Does it help you live longer?
A small 2025 trial (42 healthy adults) saw improvements in biological clocks. It has not been shown that this means more health or more years of life.
Does plasmapheresis remove microplastics?
There is no controlled clinical evidence that plasmapheresis removes microplastics with a health benefit.
Does it work for Alzheimer’s, long COVID or autoimmune diseases?
In specific autoimmune and neurological diseases, yes, in hospital and with a medical indication. In Alzheimer’s, the AMBAR trial gave promising but mixed results, and it is not an established treatment. In long COVID, a randomized trial with 50 patients (Nature Communications, 2025) did not find a clear improvement.
Is it “young blood”? Do they change all my blood?
No. Young blood is not used: albumin is used as the replacement. Not all the plasma is changed either. One exchange of one plasma volume removes, in theory, about 63% of a substance that circulates only in the plasma.
How much does it cost and does social security cover it?
At Monarka, €5,000 all included. In public healthcare it is done in hospitals for recognized medical indications. Use for longevity or wellness purposes is not covered.
In summary
- Plasmapheresis is supported for specific diseases; for longevity, it is experimental.
- It is not a detox, nor “young blood”, and there is no proof that it rejuvenates.
- Always ask what is used as replacement, what risks it has in your case and what the price includes.
Sources and references
- Connelly-Smith L. et al. Guidelines on the use of therapeutic apheresis in clinical practice (ASFA, 2023 edition). J Clin Apher 2023. DOI
- Fuentealba M. et al. Randomized trial of therapeutic plasma exchange and biological age. Aging Cell, 2025. PMC
- Jacobs J.W. et al. When strong recommendations rest on weak evidence: lessons from therapeutic apheresis guidelines. J Clin Apher, 2026. DOI
- FDA. Important information about for-profit young donor plasma infusions (2019). fda.gov
- Mehdipour M. et al. Rejuvenation of three germ layers tissues by exchanging old blood plasma with saline-albumin. Aging (Albany NY) 2020;12:8790-8819. DOI
- Therapeutic apheresis. MSD Manual. msdmanuals.com
- Furman D. et al. Chronic inflammation in the etiology of disease across the life span. Nature Medicine 2019.
- Boada M. et al. AMBAR: plasma exchange with albumin in mild to moderate Alzheimer’s disease. Alzheimer’s & Dementia 2020. DOI
- Cantero-Fortiz Y., Boada M. Plasma exchange in Alzheimer’s disease: scoping review. Front Neurol 2024. DOI
- Kim D. et al. Old plasma dilution reduces human biological age. GeroScience 2022. DOI
- Jeon O.H. et al. Systemic induction of senescence in young mice after single heterochronic blood exchange. Nature Metabolism 2022. DOI
- Kankirawatana S. et al. Continuous infusion of calcium gluconate in 5% albumin is safe and prevents most hypocalcemic reactions during therapeutic plasma exchange. J Clin Apher 2007.
- Owen H.G., Brecher M.E. Atypical reactions associated with use of angiotensin-converting enzyme inhibitors and apheresis. Transfusion 1994.
- Fortune. Bryan Johnson and plasma exchange (May and July 2023). Fortune · Decrypt (January 2025).
Informational content updated on October 9, 2026 with the sources cited. It does not replace an individual medical assessment.
Want to know if this treatment is right for you?
We assess with you whether plasmapheresis makes sense in your case. At Monarka Clinic we review your health status and, if appropriate, explain what the program would be like.
