TPE appears capable of lowering circulating microplastics — but current plastic-based treatment systems may introduce microplastics during the procedure itself, limiting benefit for patients who don't start with a high enough baseline burden.
A study published in the Journal of Clinical Apheresis in May 2026 is the first peer-reviewed research to measure whether therapeutic plasma exchange treatment can reduce circulating microplastics in human patients.Weinstein 2026 The core result is genuinely promising — but it comes with a structural limitation that determines whether any given patient would benefit.
The question worth asking before any treatment decision: does TPE help or hurt microplastic levels in the average person? Based on the data available today, we cannot answer that. Here's what the study actually shows.
What the Study Found
Weinstein and colleagues measured microplastic levels in 114 patients before and after 174 TPE procedures, dividing them into four groups based on how many microplastic particles were circulating in their blood before treatment began.
Patients were tested using a commercial dried-blood-spot assay (PlasticTox, Arrow Lab Solutions) that counts plastic particles in a small blood sample. The procedures used the same equipment and albumin-based protocol found in most outpatient TPE settings, including the PlasmaRestore™ therapeutic plasma exchange protocol. Most patients were seeking longevity support; others had POTS, ME/CFS, or long COVID. Results broke down as follows:
| Baseline (MP/100 μL) | Procedures (n) | Share of total | Pre-TPE mean | Post-TPE mean | Net effect |
|---|---|---|---|---|---|
| 0–9 | 100 | 57.5% | 4.4 | 14.4 | ↑ MPs added |
| 10–19 | 33 | 19.0% | 13.8 | 11.8 | No change |
| 20–29 | 20 | 11.5% | 23.6 | 16.1 | Small reduction |
| ≥ 30 | 21 | 12.0% | 52.2 | 21.1 | Large reduction |
Source: Weinstein et al., Journal of Clinical Apheresis 2026;41:e70135.
The pattern is stark. TPE produced a large, statistically significant reduction only in patients who started above 30 particles per 100 μL — a roughly 60% drop. In the largest group, which accounted for more than half of all procedures, microplastic levels were measurably higher after treatment than before.
Why MPs Went Up in the Low-Burden Group
The increase in microplastics at low baseline levels isn't a biological side effect of the procedure — it's a measurement of how much plastic the equipment itself sheds into the patient's bloodstream during treatment.
The IV bags, tubing, and apheresis circuit used in every TPE session are made of plastic. That plastic leaches particles into the fluids running through it — and those particles end up in the patient. The researchers measured this directly by sampling saline from various points along the circuit before connecting it to anyone:
| Sampling site | MPs per 100 μL (mean ± SEM) |
|---|---|
| 1L saline priming bag | 11 / 100 μL |
| Inlet tubing after priming (n=3) | 16.7 ± 5.4 |
| Blood warmer tubing after priming (n=5) | 18.8 ± 6.9 |
| Blood warmer tubing, 52 min at 41°C (n=5) | 25.0 ± 12.3 |
Source: Weinstein et al. 2026. Consistent with Mou et al. (2024) and Huang et al. (2025), who separately documented MP leaching from standard IV infusion materials.
The numbers tell the story. The circuit introduces roughly 15–25 microplastic particles per 100 μL of blood during a typical session. So the procedure only produces a net reduction when the patient's starting level is high enough that removing their own MPs outweighs the particles the equipment adds. Based on this study, that crossover appears to sit somewhere between 20 and 30 — with clear, reliable net benefit only demonstrated above 30.
Put another way: for patients below that threshold, today's TPE equipment may function as a source of microplastic exposure, not a solution to it.
The Missing Piece: Where Does the Average Person Fall?
To interpret this study, you need to know where the average person falls on the scale it uses. That number doesn't exist yet in published research — and that gap matters enormously.
Different tests measure microplastics differently. Most published population studies use techniques that report results by mass (micrograms per milliliter), not by particle count. The Weinstein study uses a particle count assay. The two formats can't be directly compared — there's no validated conversion between them. So while existing research suggests microplastics are detectable in most people's blood,Leslie 2022Sci Reports 2024 we can't reliably place the average person into the 0–9, 10–19, 20–29, or ≥ 30 tiers that this study uses.
The largest relevant dataset isn't published. Arrow Lab Solutions — the company whose test was used in the Weinstein study — has reported collecting results from over 5,000 blood samples across 15 countries, detecting microplastics in more than 90% of people tested. That's the world's largest dataset using the exact same methodology as this study. But they haven't published the distribution of results in peer-reviewed form. Without it, we can't say whether "≥ 30 particles per 100 μL" describes a rare outlier or a meaningful slice of the general population.
The cohort itself skews high. Weinstein's patients — seeking longevity support, POTS care, or long COVID treatment — likely carry higher microplastic exposure than the general population. Yet even in this elevated-risk group, 57.5% started below 10 particles per 100 μL and only 12% cleared the 30-particle threshold where TPE showed clear benefit. If a high-exposure population tilts this heavily toward the lower tiers, the implication for average patients is significant.
What This Study Does and Doesn't Establish
What is established: TPE can remove circulating microplastics from human blood. That's the first time it's been demonstrated in a peer-reviewed study. For patients with high starting levels — above 30 particles per 100 μL — the reduction was large and statistically convincing. The study also provides the first direct measurement of how much plastic standard TPE equipment may introduce during treatment, which is a finding with implications beyond microplastics for anyone receiving large-volume IV therapies.
The health stakes for getting this right are real. A 2024 study in the New England Journal of Medicine found microplastics and nanoplastics inside human arterial plaques, and patients who had them faced significantly higher rates of heart attack, stroke, and death over three years compared to those who didn't.Marfella 2024 That association doesn't prove that removing circulating microplastics prevents those outcomes — but it's the clearest published signal yet that this is worth taking seriously as a clinical question.
Considering therapeutic plasma exchange?
Avinity Health's PlasmaRestore™ protocol is overseen by Dr. Leslie F. Thomas — a Mayo Clinic-trained nephrologist with 20+ years of clinical TPE experience. Candidacy is reviewed individually before any treatment recommendation.
The Bottom Line
This study is a meaningful step forward. It is not yet a basis for broad clinical use of TPE for microplastic reduction — particularly without baseline testing to confirm whether a patient is above the threshold where the procedure produces net removal. The two things that would change this calculus most are:
- Published population data from the Arrow Lab dataset — showing where most people actually fall on this scale, so clinicians can tell a patient whether their level is elevated relative to the general population
- Plastic-free apheresis equipment — which would eliminate the circuit contamination problem and make the procedure beneficial for a much wider range of patients
For patients with a confirmed baseline above 30 particles per 100 μL, the current evidence supports TPE as a procedure that meaningfully reduces circulating microplastics. Patients considering therapeutic plasma exchange for this indication — including those evaluating treatment options in Scottsdale — should expect baseline testing as part of any responsible candidacy evaluation. For everyone else, the position is straightforward: test first, then decide.
Microplastics are one of several emerging areas where the broader clinical evidence base for therapeutic plasma exchange is developing — alongside longevity, cardiovascular, neurological, and post-viral applications. It's worth tracking. It's not yet worth acting on without the data to support individualized decisions.