Therapeutic Plasma Exchange for Long COVID
Outpatient TPE targeting the autoantibodies, microclots, and persistent inflammatory mediators implicated in post-acute sequelae of SARS-CoV-2 (PASC).
Important: Therapeutic plasma exchange is not covered by insurance in our outpatient setting. TPE at Purety Clinic is fee-for-service. We provide transparent pricing at consultation and a superbill you may submit for potential out-of-network reimbursement.
Why TPE for Long COVID
Long COVID is increasingly understood as a multi-mechanism syndrome driven by some combination of: persistent viral or spike-protein remnants, autoantibodies targeting adrenergic and muscarinic receptors (which produce orthostatic intolerance and dysautonomia), fibrinaloid microclots that resist normal fibrinolysis, and chronic immune activation. Conventional treatments rarely address these mechanisms directly — most are symptomatic.
Therapeutic plasma exchange is mechanistically suited to Long COVID because it physically removes the plasma fraction of the blood — including the autoantibodies, the microclots, the inflammatory cytokines, and the protein-bound circulating mediators — and replaces it with sterile albumin. Unlike a medication that blocks one pathway, TPE clears the upstream drivers that are otherwise continuously regenerated.
At Purety Clinic, Long COVID patients are evaluated by Dr. Birch for candidacy before any treatment is offered. Workup typically includes autoantibody panels (GPCR antibodies where available), microclot screening, inflammatory markers, and a thorough functional assessment. TPE is offered as part of an integrative protocol — not a standalone fix — that may also include IV nutritional support, low dose naltrexone (LDN), peptide therapy, and lifestyle medicine.
What the Research Shows
The most influential clinical evidence comes from the Charité Berlin Long COVID program led by Drs. Tölle and Scheibenbogen, where serial plasmapheresis and immunoadsorption have produced clinically meaningful improvement in fatigue, brain fog, and post-exertional malaise — particularly in patients with documented GPCR autoantibodies. Several open-label series and case reports internationally have replicated this signal.
The microclot hypothesis — developed by Resia Pretorius and Doug Kell — has shown that fibrinaloid amyloid microclots persist in Long COVID plasma and resist normal fibrinolysis. TPE physically removes these microclots from circulation, complementing anticoagulant strategies that target only forward formation.
Long COVID is not currently an FDA-approved indication for TPE, and response is variable. Some patients experience dramatic relief within 2–3 sessions; others require a full 5-session course before meaningful change; some do not respond. Honest expectation-setting is part of every consultation.
Who Is a Candidate for TPE for Long COVID?
- Symptoms persisting more than 3 months after acute COVID-19
- Predominant fatigue, brain fog, POTS, exercise intolerance, or post-exertional malaise
- Failed or intolerant to standard symptomatic management (beta-blockers, salt/fluids, pacing alone)
- Willing to undergo lab workup and informed consent for an off-label integrative protocol
- No active infection, untreated bleeding disorder, or contraindication to apheresis
Final candidacy is determined at consultation by Dr. Birch after review of your full clinical history, lab work, and treatment goals. TPE is not appropriate for every patient and we will tell you so directly when it is not the right tool.
What the Long COVID Protocol Looks Like
A typical Long COVID TPE protocol at Purety Clinic involves an initial consultation and lab workup, followed by 5 outpatient sessions delivered weekly or every other week, with a clinical reassessment after the course completes. Each session lasts roughly 1.5–2.5 hours, with a 30-minute monitoring period afterward.
Patients who respond well typically continue with a maintenance schedule (one session every 1–3 months) tailored to their lab trajectory and symptom recurrence. Patients who do not respond after the initial course are not pushed to continue — we redirect to other tools in the integrative toolkit.
Curious about the TPE procedure itself?
See our complete therapeutic plasma exchange overview, including how each session works, what the equipment looks like, and what to expect on the day of your visit.
Read the Full TPE OverviewFrequently Asked Questions: TPE for Long COVID
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Two Licensed Naturopathic Medical Doctors. One Practice.
The naturopathic medical doctors caring for our patients at Purety Family Medical Clinic.
Dr. Jonathan Birch, NMD, RMSK
Founder · Naturopathic Medical Doctor
Licensed Naturopathic Medical Doctor and Registered in Musculoskeletal Sonography. Practicing root-cause integrative medicine since 2014. Areas of focus include FMT and microbiome restoration, hormone and thyroid optimization, autoimmune and Long COVID protocols, ozone and IV nutrient therapy, and PRP and regenerative injections.
Read Dr. Birch's full bioDr. Dena Birch, NMD
Naturopathic Medical Doctor · Women's Health & Pediatrics
Licensed Naturopathic Medical Doctor leading our women's health and holistic pediatric care. Areas of focus include perimenopause and bioidentical hormone therapy, PCOS and thyroid, fertility support, pediatric eczema, immune issues and recurrent infections, and gentle well-child care for families.
Read Dr. Dena's full bioDiscuss TPE for Long COVID with Dr. Birch
Call (805) 500-8300 or submit a consultation request. Remote consultations available for patients outside Santa Barbara.
(805) 500-8300