A long-established hospital procedure that removes blood plasma and replaces it with a salt-and-albumin fluid, now explored for aging by clearing harmful factors from older blood. It reliably lowers cholesterol particles and inflammatory proteins for a time. Longevity benefits are early, contested, and temporary; costs and risks are real. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Ionized calcium | 1.12–1.32 mmol/L | Citrate binds calcium; most common side effect |
| hs-CRP | < 1.0 mg/L | Tracks the inflammatory load TPE aims to lower |
| Fibrinogen | 200–400 mg/dL | Depleted by exchange; low levels signal bleeding risk |
| IgG | 700–1600 mg/dL | Falls with repeated TPE, raising infection risk |
| Apolipoprotein B | < 60 mg/dL (lower if high-risk) | Primary atherogenic particle count that TPE acutely lowers |
| Lipoprotein(a) | < 75 nmol/L (≈ < 30 mg/dL) | Inherited risk particle strongly cleared by apheresis |
| Serum albumin | 4.0–5.0 g/dL | Reflects replacement adequacy and nutrition |
| Magnesium & potassium | Mg 2.0–2.5 mg/dL; K 4.0–4.5 mmol/L | Shifted by citrate; low levels worsen cramps and rhythm risk |
| Epigenetic age (DNAm clock) | Lower than chronological age | The surrogate endpoint used to define "rejuvenation" |
Cadence: Ionized calcium during each session; coagulation and metabolic panel 24–72 h after early sessions; lipids, inflammatory markers, immunoglobulins, and epigenetic age at baseline then roughly every 3–6 months.