Plasma exchange

Description:

Plasma exchange — plasm (plasma (blood)) + aphairesis (otnyaty or removal).

The plasma exchange shares on medical and donor.

Depending on a method of receiving plasma plasma exchanges allocate hardware, centrifugal, membrane and sedimentation (upholding). During a plasma exchange from an organism the portion of blood in system, in a bottle, in a haemo-container which then, depending on a method, is divided into plasma and uniform elements (blood cells — erythrocytes (red blood cells), leukocytes (white blood cells), thrombocytes (the cell participating in blood coagulation process) is taken, blood cells are returned to an organism, and remote plasma, depending on that, medical it is a plasma exchange or donor, is utilized or used for transfusion or for receiving components or blood preparations. If plasma is exposed to other methods of influence, such as cold and is returned, then such procedure is called криоферез. Donor plasma exchange - strictly regulated procedure, volumes of remote plasma, frequency rate of the procedure are strictly regulated in the Russian Federation "The law on donorship" and instructions.

Therapeutic plasma exchange.

Take a certain amount of blood from the patient and delete from it a liquid part — plasma which contains toxic and metabolic components (blood consists of two components — uniform elements and plasma).

Use in treatment of neurologic, autoimmune diseases when bystry removal of antibodies is necessary. It is used in the absence of effect of glucocorticoids at multiple sclerosis, an opticomyelitis, neuropathy, HIV, sepsis, plague, a sarcoidosis, a syndrome of long squeezing. At treatment of similar immune diseases the bystry effect due to removal of aggressive antibodies is observed.

The procedure of a plasma exchange is carried out via the special device which is completely excluding a possibility of infection of the patient with hepatitises and HIV, the procedure lasts about one and a half hours.

Now use of a plasma exchange at therapy of many diseases, including asthmas, a pseudorheumatism, an idiopathic hypertensia is widespread in Russia. There are no bases for similar treatment, as a rule, proofs of its usefulness are absent.

Membrane plasma exchange.

Membrane plasma exchange — removal from an organism of various pathological products (toxic or ballast elements) by removal of a blood plasma through filtering of blood in plasma filters.

The membrane plasma exchange as a method of efferent therapy finds more and more broad application in clinical practice. Many diseases of the person are followed by disturbances of structure of internal environment which in many respects define weight of disease and even are the main reasons for failures, despite use of the most modern medicamentous means or surgical interventions. Such problems arise at acute inflammatory diseases of bodies of chest and belly cavities, severe injuries and burns, poisonings and infectious diseases when the syndrome of endogenous intoxication with secondary suppression of an immunological defense system develops. The immune distress a syndrome" develops some kind of ". In such situation the detoxication with removal of endotoxins and other pathological products allows to achieve a change during diseases.

The leading role is played here by the plasma exchange allowing, in addition to removal of endotoxins, to remove also all incompetent components of humoral immunity. Substitution of the deleted volume donor plasma promotes more effective system recovery of protection to both more bystry and absolute recovery. In general are considerably reduced the period of finding of patients in intensive care units, the general duration of treatment, decreases a lethality.

However and at the most different chronic diseases of the person of disturbance of structure of its internal environment, frustration of a biochemical and immune state define weight of their current and the reason of synchronization of pathology. At the same time only by means of a plasma exchange removal of allergens, autoantibodies and cell-bound immune complexes at allergies and autoimmune diseases is possible. Introduction of a plasma exchange to the scheme of complex therapy of the autoimmune disseminated pulmonary diseases allowed to try to obtain more permanent remission at reduction of volume of hormonal therapy for 40% and almost full refusal of tsitostatik, practically to double life expectancy of this category of patients.

Removal of products of the broken lipidic exchange allows to control the course of atherosclerosis and its complications. The plasma exchange is able to liquidate serious consequences beam and chemotherapy in oncology. Its high performance at hroniointoksikation, including drug addiction and alcoholism is shown that has not only the medical, but also high social importance.

Wide perspectives open in treatment of toxicoses of pregnant women, a Rhesus factor conflicts, the "latent" urogenital infections, an anti-phospholipidic syndrome that can reliably prevent disturbances of pre-natal fetation and reduce the level of perinatal mortality, recover demographic balance.

After the postponed viral hepatitis, especially In and With, autoimmune chronic hepatitis with the subsequent transition to irreversible cirrhosis and even primary cancer of a liver inevitably forms. By means of a plasma exchange it is possible to remove autoantibodies and pathological metabolites that it is capable to suspend progressing of damages of a liver. Considering a huge number of the people infected with these viruses of hepatitis this problem also has great social value.

At first sight the diabetes mellitus does not pose a serious threat as by means of insulin or tablets it is possible to support sugar level at the acceptable level. However and at such treatment the secondary exchange disturbances which are inevitably leading to the vascular frustration causing irreversible loss of sight, disturbance of passability of vessels of the lower extremities, heart and brain that much more reduces the general life expectancy are not prevented. By means of a plasma exchange it is possible to reduce considerably potential risk of these secondary complications of diabetes.

Plasma exchange methods.

The main methods of a plasma exchange — filtrational and gravitational.

The first method is based on filtering of blood in special plasma filters. In the world plasma filters from hollow porous fibers are issued. In Russia the PFM-800 plasma filters consisting of flat "track" porous membranes in JSC Optika were for the first time marketed (nowadays — in CJSC Plazmofiltr, St. Petersburg). In 2001 there was a Dew plasma filter developed and released in Moscow area.

The second is carried out by centrifuging of blood with constant or its discontinuous flow in the special devices PF-05, PF-3-05, FK-3,5 or foreign Gambro, Fresenius, COBE, Dideco, Terumo or in packages (bottles) in RS-6, OS-6, TsL-3,5 centrifuges.

Creation of an artificial hypovolemia starts the most ancient and powerful reflex of a priority of recovery of the circulating volume and "breakthrough" of an intercellular lymph promotes alignment of concentration in these spaces during the next few hours.

Cascade plasma exchange.

Cascade plasma exchange (cascade or double-filtration plasmapheresis) — repeated filtering of a blood plasma via the special microporous filter which passes only low-molecular proteins (albumine) and detains krupnomolekulyarny including atherogenous lipoproteids.

It was for the first time implemented in clinical practice in 1980 in Japan when T. Agishi with colleagues offered the first filter for division of already received plasma on low - and krupnomolekulyarny fractions. Since then also this new progressive medical technology with coverage all of the extending range of diseases began to develop. Among them are main a hypercholesterolemia at atherosclerosis with the heaviest vascular damages of heart, brain, aorta and peripheral arteries, the causing myocardial infarction, a stroke, aneurisms with ruptures of an aorta and gangrene of the lower extremities. In total, such vascular frustration are the most frequent cause of death in our country (more than 50% of the general mortality).

Besides, efficiency of a cascade plasma exchange is proved and at various forms of the hardest and incurable autoimmune diseases in the most different fields of medicine. In hematology it is a multiple myeloma, a trombotichesky Werlhof's disease, a paraproteinemia and a macroglobulinemia, a gemolitiko-uraemic syndrome, a monoclonal gammapathy and an amyloidosis; in rheumatology it is a system lupus erythematosus, a scleroderma, a pseudorheumatism, ulcer colitis and a disease Krone; in pulmonology — fibroziruyushchy alveolites and a sarcoidosis; in neurology — multiple sclerosis, a malignant myasthenia, a syndrome to Giyena-Barra and chronic inflammatory polyneuropathy; in dermatology — a pemphigus and violent pemphigoid, an epidermal toxic necrolysis (Lyell's disease); AVO and Rhesus factor incompatibility in transplantology and obstetrics; in nephrology — a glomerulonephritis with a heavy nephrotic syndrome; in surgery and resuscitation — sepsis and multiorgan insufficiency, and also at various poisonings, fulminantny forms of hepatitis with an acute liver failure and many others. At all these diseases mentioned above the most optimistic results of their treatment, not achievable by means of standard methods of efferent therapy including a massive plazmoobmen, by means of the most modern medicines are received earlier.