Plasmapheresis - Causes, symptoms and treatment. MF.

Plasmapheresis is the process of removing blood plasma from the circulation. Occasionally used as a method of treatment, but most often used to collect donor plasma.

Plasmapheresis is a method based on the removal of plasma from the blood without removing the blood elements and replacing the plasma with blood-filling fluids. In this case, antibodies, immune complexes, inflammatory mediators, lipids, cholesterol, endotoxins( ie those substances that are harmful to the body) are removed from the patient's plasma;decreases the viscosity of the blood, improves its fluidity, increases sensitivity to medications taken, reduces the toxic effect, there is a correction of immunity.

Plasmapheresis ( from the Greek "apheresis" - removal) is a modern method of treating diseases. The procedure is to divide the blood into cells and cellular elements( red blood cells, leukocytes, platelets, etc.) and plasma, i.e.the liquid part of the blood in which pathological and metabolic components are dissolved - carriers of the causes of diseases. Plasma is separated from the cellular elements and removed along with toxins and pathological elements, in the body it is replaced with various solutions( crystalloids - glucose solution, physiological solution, or dextrans - rheopolyglucose, starch preparations), cells and cellular elements are returned to the patient.

The main mechanism of the therapeutic effect of plasmapheresis is detoxification.

Mechanisms of action( levels of influence) of plasmapheresis:

1. 1. Increase of compensatory-adaptive reactions.
   2. Normalization of hormones of the hypothalamic-pituitary-adrenal-ovarian system.
   1. Normalization of oxygen metabolism.
   2. Normalization of metabolic orientation.
   3. Normalization of immunoregulatory disorders.
   1. Improvement of microcirculation of vital organs.
   2. Normalization of systemic hemodynamics.
   1. Antihypoxic effect. Protection from end products of lipid peroxidation and intoxication products.
I. At the level of the body: II.At the cellular level: III.At the organ level: IV.At the level of biomembranes:

The inclusion of plasmapheresis in the treatment complex is indicated in pathological conditions, which are accompanied by intoxication, hypercoagulation, violations of the function of natural detoxification systems, tissue respiration, autoimmune aggression.

Currently, the plasmapheresis method of is widely used in clinical practice. According to the protocols of the World Association for Haemapheresis( 1993, 1997, 2000), complex therapy of more than 200 diseases includes plasmapheresis. As an effective method of detoxification, plasmapheresis is widely used: from toxicology, narcology, rheumatology, hepatology to dermatology and cosmetology.

Indications for plasmapheresis are constantly increasing: chronic infectious diseases, intoxications of various etiologies, autoimmune diseases, various types of allergies, systemic diseases of connective tissue and skin.

Plasmapheresis is used in the treatment of the following diseases:

• Chronic intoxication, acute intoxication;
• Atopic dermatitis, psoriasis, neurodermatitis;
• Chronic alcoholism, heroin addiction;
• Bronchial asthma, chronic bronchitis, pleurisy, alveolitis;
• Glomerulonephritis, nephrotic syndrome, renal failure;
• Diseases of the blood: paraproteinemic hemoblastoses, cytopenic syndromes;
• Multiple sclerosis, polyneuritis of various origin, amyotrophic lateral sclerosis, Alzheimer's disease;
• Nonspecific ulcerative colitis, Crohn's disease, diffuse liver disease, viral hepatitis, cirrhosis, hepatocerebral encephalopathy;
• Diabetes mellitus, autoimmune thyroiditis, thyrotoxicosis;
• Systemic connective tissue diseases: hemorrhagic vasculitis: roar-matoid arthritis, systemic lupus erythematosus, polyarthritis;
• Ischemic heart disease, postinfarction syndrome, hypertensive disease, viral myocarditis, autoimmune cardiomyopathies;hypercholesterolemia.

In addition to purification of blood from harmful substances, its rheological properties are improved - viscosity decreases, microcirculation improves. This increases the ability to respond to drug therapy.

For a persistent positive effect, plasmapheresis is performed by the course from 3 to 6 procedures. The average duration of the blood purification procedure is 1.5 - 2 hours .In our clinic, the technique of membrane plasmapheresis is used to remove plasma.

Contraindications to plasmapheresis.

1. ABSOLUTE CONTRAINDICATIONS:
   • irreversible damage to the brain and other vital organs,
   • unidentified bleeding,
   • blood disorders, accompanied by reduced coagulability.
2. RELATIVE CONTRAINDICATIONS:
   • increased bleeding or a high risk of bleeding( for example, with "stressful" ulcers or erosions of the gastrointestinal tract), however, it is possible to perform membrane plasmapheresis operations, but without the use of heparin;
   • unstable hemodynamics, however, plasmapheresis is also possible, but under the "cover" of dopminas or other sitmatomimetics or pacemakers;
   • hypoproteinemia, however, plasmapheresis is possible under the condition of synchronous compensation of the removed volume of donor plasma, protein preparations or colloidal plasma substitutes;
   • acute respiratory or intestinal infections in critical conditions are not obstructions, but planned plasmapheresis is advisable only after 2-3 weeks after recovery;
   • menstruation;
   • macroglobulinemia, cryoglobulinemia, valendenstrom disease, myeloma( in these cases it is more reasonable to perform gravity centrifugal separation of blood( discrete plasmapheresis).)