Plasmapheresis indications and contraindications reviews of immunologists

  • Sedimentation – plasma separation occurs due to sedimentation. In this case, blood cells gradually precipitate.
  • Centrifugal – the separation process is accelerated by the action of centrifugal force on the formed elements of the blood.
  • Filtration – special plasma filters are used.
  • Membrane – based on the use of special semi-permeable membranes that pass plasma, but do not pass blood cells.
  • Cascade – in this case, the already obtained blood plasma is repeatedly passed through a special filter that passes only low molecular weight blood proteins (albumin) and delays the high molecular weight (lipoproteins).
  • exogenous intoxication:
    • food poisoning;
    • overdose of drugs;
    • effects of chemotherapy;
  • endogenous intoxication – severe diseases accompanied by severe intoxication of the body:
    • osteomyelitis;
    • severe infectious processes;
    • paraneoplastic syndrome;
  • autoimmune diseases:
    • rheumatoid arthritis;
    • bronchial asthma;
    • multiple sclerosis;
    • Guillain Barre syndrome;
    • glomerulonephritis;
  • blood diseases:
    • myeloma
    • macroglobulinemia;
    • paraproteinemia;
    • thrombocytopenic purpura;
    • monoclonal gammopathy.
  • amyloidosis;
  • hypercholesterolemia in combination with severe atherosclerosis;
  • donation.
  • Absolute:
    • ongoing bleeding;
    • bleeding disorder.
  • Relative:
    • risk of bleeding, for example, peptic ulcer of the stomach and duodenum; if a decision is made on the need for plasmapheresis, the procedure is carried out without the use of heparin;
    • unstable hemodynamics;
    • hypoproteinemia;
    • acute infectious processes;
    • menstruation.

Many domestic commercial medical institutions often unreasonably prescribe plasmapheresis, telling patients tales and fables about its miraculous properties. Here is some of them:

  • has a rejuvenating effect;
  • cleanses of toxins (no such slags exist in the body and cannot exist);
  • can be used to prevent almost all diseases;
  • normalizes hormones;
  • normalize metabolism;
  • normalize immunity;
  • improves microcirculation in organs and tissues – this is true, but it is associated not with plasmapheresis, but with the action of heparin, which is used during the procedure;
  • everything that comes to mind the doctor, hungry for profit or suffering from medical perversion.

It is important to understand that plasmapheresis “does only what it does” – reduces the concentration of certain substances in the blood. It does not prevent their formation in the body, does not relieve the cause, and in most cases it is used only in complex therapy. Thus, its carrying out is shown only in the case when in the blood there is an increase in a substance negatively affecting the body, and the risk of complications from the procedure does not exceed the risks associated with the underlying disease.

  • pulmonary edema;
  • allergic reactions, including anaphylactic shock;
  • bleeding disorder and associated bleeding;
  • infection with hepatitis B virus, hepatitis C, HIV;
  • hypotension (lowering blood pressure);
  • phlebitis;
  • mortality from complications: 1 in 5000 people.

This is a modern technique of cleansing the body at the cellular level by filtering blood using special devices. It is designed to treat many diseases and is the only salvation for some very rare diseases. The term “plasmapheresis” consists of two words – “plasmas” and “apheresis”, which can be literally translated from Latin as “plasma removal”.

The procedure is carried out in state medical institutions, private clinics and even sometimes at home. Plasmapheresis of blood has earned recognition at the end of the last century, but has already managed to save the health of hundreds of thousands of people.

There are three main classifications of plasmapheresis.

1. By appointment

If blood purification is of a therapeutic nature and is used to eliminate any disease or pathological condition, this is therapeutic plasmapheresis. In this case, the filtered shaped elements are returned back to the patient’s body, and the plasma is replaced by donated blood or a special solution.

If blood separation is carried out in order to obtain plasma from a healthy person for its further use, then this procedure is called donor plasmapheresis.

2. According to the method of conducting

There is a plasmapheresis discrete and automatic. In the first case, a sufficiently large volume of blood is taken from the patient, placed in a sterile container with preservatives, and the plasma is separated by centrifugation or sedimentation. Then the patient is injected intravenously remaining after removal of the plasma cell mass, diluted with saline. This method is also called manual.

With automatic plasmapheresis, blood sampling, filtration and its return to the vessel are carried out in small portions using a separation apparatus. Moreover, all processes occur continuously. This method is more comfortable for the patient, much more mobile, and also prevents cell damage, unlike manual.

3. According to the method of removal and processing of plasma

Depending on the technique by which the liquid part is removed, plasmapheresis is divided into:

  • Centrifugal.
  • Membrane
  • Cascading.
  • Sedimentation (non-apparatus plasmapheresis).
  • Cryoplasmapheresis.

Each of the methods has its pros and cons. The most popular is membrane plasmapheresis. The sedimentation method is almost never used, but it is much cheaper than the rest.

Recently, this expensive procedure is positioned as a panacea for all diseases. Private clinics are particularly active in promoting plasmapheresis. The benefits and harms of this method are directly dependent on the professionalism of doctors. But just like any other method of treatment, it has its own side effects and disadvantages:

  • Anaphylactic shock.
  • Allergies to donated plasma and flu >

This is a very serious and complicated procedure, so you need to be careful in choosing a place for treatment. In many private clinics, patients are offered plasmapheresis. What kind of institutions are these, what kind of specialists work there, are there permissions to carry out this procedure? All this must be known before agreeing to therapy, so as not to fall into the hands of uneducated scammers. After all, this can lead to a deplorable outcome.

History of the origin of the method

This method is rooted in the use of bloodletting as a treatment for any disease. For a long time this “barbaric” method of therapy was forgotten by doctors, but by the middle of the th century, specialists began to attempt to create an apparatus for dividing blood into phases and removing its liquid part to obtain a therapeutic effect.

Already in the 70-80s, plasmapheresis began to be actively used in the USA and gained popularity in the USSR. But the evidence for the effectiveness of the method was not yet high enough, because clinical studies require many years of work. However, scientists did not back down and continued to study plasmapheresis. What has this brought to humanity?

Description of methods

The centrifuge method is based on the laws of gravity. The device provides blood rotation at high speed, due to which it is divided into fractions. In this case, the formed elements are returned to the body, and the plasma is removed. This method is considered obsolete, it has many contraindications, in addition, cell centrifugation often causes injury.

The membrane method involves the use of an apparatus equipped with special filters with pores that pass through the plasma, and the shaped elements are delayed. This technique has its advantages:

  • Sterility of plasma filters.
  • Infection protection.
  • The speed of the method.
  • There are few contraindications.
  • The cells are not damaged.
  • The possibility of applying the procedure for the treatment of cancer patients.

The cascade method is characterized in that the blood undergoes double treatment. First, the cell mass is separated, and then the plasma is filtered, being purified from large molecules, proteins and lipids. This technique is popular in the treatment of atherosclerosis.

Non-apparatus plasmapheresis (or sedimentation) is carried out without the use of any special devices. Blood is divided into two phases under the influence of gravitational forces. This is a very simple and inexpensive plasmapheresis. Its price is significantly different from the cost of other methods. But he does not allow to process large volumes of blood.

Cryoplasmapheresis involves the removal of plasma with its freezing at a temperature of -30 ° C, and then heating to 4 ° C, followed by centrifugation. Part of the liquid that has precipitated is removed, and the remaining plasma is returned back to the patient.

The physiological effect of the procedure

The plasmapheresis procedure allows you to cleanse the body of residual metabolic products (urea, creatinine, uric acid), antibodies, antigens, hormones, high molecular weight lipids, inflammatory mediators and other harmful substances. Removal of plasma causes artificial hypovolemia, which provokes the inclusion of all the compensatory and protective forces of the body.

However, after a day, the amount of toxins in the blood is restored again. Therefore, experts recommend a course of plasmapheresis, designed for 3-4 visits. With each subsequent procedure, a new level is cleared: first the vessels, then the tissues, then the cells. The rheological properties of blood change in a positive direction, excessive viscosity is eliminated, blood supply and oxygen supply to organs and tissues increase. This provides an improvement in the general condition of the body, an increase in adaptive abilities, and also relieves intoxication symptoms with harmful compounds.

However, relying only on blood plasma exchange is not worth it, since it is always important to carry out complex treatment of any disease, following the doctor’s instructions.

Who is shown this procedure

Now many doctors prescribe plasmapheresis. What is this procedure – most patients do not even imagine. Meanwhile, to know under what conditions it is worth agreeing to such a method of treatment, of course, is necessary. Plasmapheresis is a body cleansing that is recommended for the treatment of diseases of almost all human organs and systems.

  • sickle cell anemia;
  • thrombocytosis and leukocytosis;
  • erythroleukemia;
  • porphyrin disease;
  • hypercholesterolemia (hereditary);
  • Rufus disease
  • DIC-syndrome;
  • hyperviscose syndrome;
  • myasthenia gravis;
  • Guillain-Barré syndrome;
  • delayed thrombocytopenia;
  • myoglobinemia;
  • intravascular hemolysis;
  • Goodpasture syndrome;
  • Gasser syndrome;
  • thrombocytopenic acroangiothrombosis;
  • cryoglobulinemia;
  • chronic polyneuropathy;
  • poisoning by poisons.

Relative indications for plasmapheresis are:

  • Gastrointestinal pathologies: ulcerative colitis, Crohn’s disease.
  • Cardiovascular diseases: condition after a heart attack, myocarditis, rheumatism, etc.
  • Allergies: atopic dermatitis, pollinosis, etc.
  • Dermatological diseases: psoriasis, pemphigus, herpes, etc.
  • Pathologies of the kidneys: glomerulonephritis, urinary tract infection, etc.
  • Respiratory system diseases: bronchial asthma, hemosiderosis.
  • Liver problems: autoimmune hepatitis, etc.
  • Purulent-septic complications after operations.
  • Systemic vasculitis.
  • Toxic lesions in cancer.
  • Atherosclerosis.

Recently, gynecologists have advised to carry out plasmapheresis during pregnancy, if a woman suffers from toxicosis, there is a Rhesus conflict or fetoplacental insufficiency. This list goes on for a very long time. After all, there are about 200 diseases in which plasmapheresis can be successfully used. Contraindications to this method are also available.

Who will have to abandon such a procedure

There are not many contraindications for this procedure. But it is strictly forbidden to carry out it in the presence of irreversible damage to organs, with unstoppable bleeding, violation of coagulability and with stomach ulcers.

Blood purification is not recommended in case of rhythm and heart rate disturbances, pressure surges, decreased blood viscosity, menstruation, acute infectious diseases, hypoproteinemia, anemia in elderly patients, various types of shock, serious liver diseases, “bad” veins.

It used to be that plasmapheresis during pregnancy is dangerous for the health of the baby, but modern studies prove the opposite. Naturally, subject to the procedure strictly according to indications and according to the instructions.

Thus, some conditions exclude the possibility of using plasmapheresis as a method of treatment. Contraindications should be evaluated by the attending physician, especially if there is a risk of a deterioration in the patient’s health status when the procedure is refused.

Stem cell therapy

Plasmapheresis does not require special preparation. Typically, the procedure is carried out in special handling rooms or directly in the patient’s room. To do this, the patient lies on a special couch and takes a comfortable position. Depending on the method, a special catheter (flexul) is inserted into one or two hands.

The procedure lasts about 1-2 hours. It depends on the method and the amount of blood being cleaned. During all manipulations, the patient is constantly under the supervision of a doctor. His heart rate, blood pressure are measured, respiration and oxygen supply to tissues are checked.

Plasmapheresis devices are portable or stationary. The former are much more convenient since they can be transported to any place in the hospital or even to the patient’s home. The device takes the blood portionwise, about 40 ml at a time, cleans it, returns it through the catheter and takes the blood again. Some devices use automatic administration of anticoagulants. In one minute, the plasmapheresis apparatus is able to process about 100 ml of blood, i.e., approximately 800 ml of excess fluid can be removed in an hour.

Experts recommend removing no more than a quarter of the circulating plasma in one session. Doctors calculate this indicator depending on the individual characteristics of the person: weight and volume of circulating blood (BCC).

80 x 75 x 0,55×0,25 = 825 ml.

It is very important to observe all proportions when conducting plasmapheresis. The benefits and harms of the treatment technique depend on many factors, including the accuracy of the calculations.

The latest, but still experimental, treatment for a wide variety of diseases. One of the services offered is rejuvenation.

Stem cells are the precursors of cells that make up the organs and tissues of an adult; there are especially many of them in the bud, but in an adult, they remain in small numbers.

They started talking about the possibilities of using stem cells in therapy after American scientists discovered the embryonic stem cell line in 1998, and in 1999, the authoritative journal Science called this discovery one of the most significant in biology. Since then, serious research in this area follows one after another.

Not all of them are encouraging. The results of one of the most recent studies published in the journal Nephrology Dialysis Transplantation (Oxford University Press). For two years, scientists have observed more than a hundred patients with serious kidney disease who underwent stem cell transplantation. The results are called “very controversial.”

Nevertheless, stem cell treatment is practiced: in Russia, for example, they are involved in the Hematology and Cell Therapy Clinic of the National Medical and Surgical Center, which is led by former Minister of Health Academician Yuri Shevchenko. Cell therapy is used in the complex treatment of multiple sclerosis and disorders in the immune system.

In addition to scientific centers, there are clinics practicing “rejuvenation” using stem cell transplantation. This application of the procedure is precisely what alarms specialists. Head of the Department of Tumor Biotherapy, Russian Cancer Research Center named after N. N. Blokhina, Professor Lev Demidov, believes that stem cell therapy should be extremely careful.

“Stem cells are the precursors of not only healthy cells of various organs, but also cancer cells. We cannot control the development of a transplanted stem cell; there is an additional risk of developing a cancerous tumor, ”says Demidov. “Moreover, today there is a scientific hypothesis that it is precisely human own stem cells that can trigger the development of cancer.” According to the professor, to talk about the introduction of stem cell therapy into widespread practice is “too early.”

It is offered to everyone as a method of “purifying the blood of toxins” to improve overall well-being.

The procedure resembles an ordinary dropper: blood taken from a vein (usually no more than 450-500 ml at a time) is separated in a centrifuge into the cell mass and the liquid part (plasma), the cell mass is diluted with saline and returned to the patient. Plasma, which contains toxins and other harmful substances, is destroyed. As an option, there is membrane plasmapheresis.

Doctors usually use plasmapheresis for serious diseases that require correction of blood composition. For example, since 1975, methods of extracorporeal hemocorrection (plasmapheresis is one of its types) have been used at the Research Institute of Transplantology in preparation for organ transplant operations and in order to avoid fatal complications after organ transplantation.

Judging by the prevalence (offered by most large private and state clinics), plasmapheresis is very popular: the description of the procedure contains the magic word “detoxification”, which allows everyone who wants to “cleanse” the blood to offer this manipulation. At the same time, the head of the advisory department of the cardiology clinic of the Moscow Medical Academy. THEM.

Sechenova Sergey Shornikov does not consider the use of plasmapheresis for routine “blood purification” justified: “We can sometimes prescribe plasmapheresis to normalize the content of blood fats (lipids). But this process, firstly, is uncontrolled, and secondly, after a fairly short time, the lipid content returns to its original level.

As for the simple “purification of blood from toxins,” in terms of risk – benefit leadership is clearly at risk. ” Shornikov says that “together with the notorious toxins,” proteins that regulate a large number of chemical processes in the blood are removed. “The body does not always restore them evenly. Take, for example, a blood coagulation system.

After plasmapheresis, this system can be unbalanced. In the process of recovery, blood clots, blood clots can form in the blood. They, in turn, can lead to a heart attack or stroke. Such a development of events is unlikely, but possible, therefore I would not recommend using plasmapheresis for “preventive” purposes. “

What results should be expected

The effectiveness of plasmapheresis has been proven in the case of many diseases. The positive effect of the procedure is regularly recorded even with relative indications. However, it should be understood that monotherapy can not always help. Therefore, it is so important to undergo complex treatment with qualified specialists, not counting on healing from one course of plasma removal.

To achieve good results, you must be confident in the quality of the assistance provided and undergo a preliminary examination to confirm the absence of contraindications to the use of such a treatment technique as plasmapheresis.

The price of this procedure is quite high (4500-5500 thousand rubles), and the patient will need not one or two, but 3-4 sessions, otherwise there will be no sense in treatment. This should be considered. However, many clinics offer discounts if the duration of the course exceeds 5 sessions. It should be noted that this procedure cannot be cheap, because equipment and materials are now quite expensive. Therefore, you should not trust the clinics in which the procedure is carried out at a very low price.

To summarize

Yes, such therapy hurts the patient’s pocket, but it’s worth it. Improving the general condition, the inclusion of all protective and compensatory functions, normalizing the rheological parameters of blood, removing symptoms of intoxication – this is not the whole list of the positive effect of the procedure under consideration on the body.

Plasmapheresis is an innovative technique that helps many patients cope with their ailments and cleanse the blood from “contaminated” plasma. This procedure is indicated for a huge number of diseases and has very few contraindications. Plasmapheresis with the help of qualified specialists and following all the instructions gives positive results in the treatment of even the rarest diseases.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.