I disagree. Using PLEX right after IVIG means you've just removed a lot of the latter from circulation. It's a retrospective study, but this demonstrated a lack of benefit from additional PLEX. If anything it was just more expensive and patients were hospitalized for longer. Oczko-Walker et al., P...

I think we all agree on PLEX as the proper management in this case. 

Important point: this is why deciding from the beginning what to use as first-line treatment is influenced by how impaired the patient's functions are. In patients who are "crashing" with issues of breathing and autonomic problems, the best treatment in my opinion is PLEX. These patients should be c...