Therapeutic plasma exchange in a patient with myasthenia gravis.

Tom was an interesting combination of a patient requiring both renal placement therapy and TPE. Because there are available through the inpatient dialysis unit, it provided an opportunity to educate Tom on apheresis treatments as well as treatment options for chronic disease. Discussion with Tom during these treatments revealed that he wanted to retain as much autonomy and responsibility for his care as possible. Collaboration with the nephrologists and neurologist, as well as the outpatient infusion center, allowed Tom to schedule treatments before he experienced a myasthenic crisis but also hospitalization, which could increase his risk of infection. The time he spent receiving the TPE treatments was a unique and wonderful opportunity to answer all of Tom's questions about treatment modalities and allowed nursing staff to advocate fully for his wishes. At the time of this writing, Tom has remained free of myasthenic symptoms and has not required TPE treatments for over two years.