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Background Plasma exchange (PLEX) is a therapeutic process involving the extracorporeal separation of plasma and cells. Removed plasma is often replaced with human albumin solution (HAS). This process is used to treat various neuro-inflammatory disorders.Aims Primary objectives To identify the extent and causes of delays when conducting PLEX in a territory centre’s Acute Neurology Unit (ANU).Secondary objectives To record the indications, response rate and complication rates for PLEX.Methods We retrospectively reviewed 33 patients‘ medical records from January 2023 to August 2024 in a tertiary neurological centre.Results PLEX course was completed on time on 20% of occasions, with delays mainly arising from central line insertion and albumin shortage. PLEX was administered for over 18 separate indications amongst 33 patients. Patients receiving PLEX following a new diagnosis demonstrated a greater clinical improvement compared to those treated for a relapse. Complications were predominantly related to central line use.Conclusions PLEX is increasingly used to treat a wide range of neurological disorders. Service pressure is leading to delays and prolonged hospital stays. Introducing a day-case service for conditions suitable for outpatient management could reduce delays and hospital admissions, as well as improve coordination of clinician schedules and albumin supply.jessie.so@doctors.org.uk