This report summarizes the first year of experience with therapeutic plasmapheresis at Human Hospital-Alaska. Eleven patients had plasmapheresis; 6 patients with the Guillain-Barré syndrome, and patients with thrombotic thrombocytopenic purpura (TTP), Eaton-Lambert syndrome, myasthenia gravis, post transfusion purpura, and multiple myeloma complicated by hyperviscosity and coagulopathy. Many of our patients appeared to benefit from plasmapheresis, but we also report a variety of complications. Our approach to establishing plasmapheresis in a community hospital setting is discussed.