Plasmapheresis - what is it? Plasmapheresis: benefit and harm, contraindications, prices and methods. Therapeutic plasmapheresis

Many modern clinics in the last decade began to offer one expensive procedure - plasmapheresis. What is it and under what diseases is it shown? Is this method dangerous and how is it conducted? These are the main questions that arise in patients when they are recommended an innovative way to cleanse blood of "slag".

What is plasmapheresis?

This is a modern method of purifying the body at the cellular level by filtering blood with the help of special devices. It is designed to treat many diseases and is the only salvation in some very rare diseases. The term "plasmapheresis" consists of two words - "plasmas" and "apheresis", which can literally be translated from Latin as "removal of plasma."

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

History of the origin of the method

This method goes back to the time of using bleeding as a cure for any disease. For a long time this "barbaric" method of therapy was forgotten by doctors, but by the middle of the 20th century, specialists began to make attempts to create an apparatus for dividing blood into phases and withdrawing its liquid part to obtain 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 of the effectiveness of the method was not yet high enough, because clinical studies require many years of work. However, the scientists did not retreat and continued to study plasmapheresis. What does this bring to mankind? Persistence of scientists gave medicine a perfect and effective way of purifying blood. At the moment, the removal of "contaminated" plasma is considered a very effective method in many pathological conditions, which are accompanied by various intoxications of the body.

What kinds and methods of plasmapheresis exist

There are three main classifications of plasmapheresis.

1. By appointment

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

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

2. By the way

There is a plasmapheresis discrete and automatic. In the first case, the patient takes a sufficiently large volume of blood, places it in a sterile container of preservatives and separates the plasma by centrifugation or precipitation. Then the patient is administered intravenously the remaining cell mass after removal of the plasma, diluted with saline solution. This method is also called manual.

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

3. By 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.
• Cascaded.
• Sedimentary (nonspecific plasmapheresis).
• Cryoplasmophoresis.

Each of the methods has its pluses and minuses. The most popular is membrane plasmapheresis. The sedimentation method is practically not used, but it is much cheaper than the others.

Description of the techniques

The centrifuge method is based on the laws of gravity. The device ensures the rotation of blood at a high speed, due to which it is divided into fractions. In this case, the uniform elements return to the body, and the plasma is removed. This method is considered obsolete, it has many contraindications, in addition, when centrifuging often occurs injury cells.

The membrane method involves the use of a device 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.
• Protection against infection.
• The speed of the method.
• There are few contraindications.
• Cells are not damaged.
• Possibility of applying the procedure for treating cancer patients.

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

Unparalleled plasmapheresis (or sedimentation) is performed 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 it does not allow to process large amounts of blood.

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

Physiological effect of the procedure

The procedure of plasmapheresis allows to purify the body of the residual metabolic products (urea, creatinine, uric acid), antibodies, antigens, hormones, high molecular lipids, mediators of inflammation and other harmful substances. Removal of plasma causes artificial hypovolemia, which provokes the inclusion of all the compensatory and protective forces of the body. In addition, the liquid from the tissues rushes into the vessels to restore the volume of circulating blood. This leads to a reduction in swelling and reduces the toxic effect of harmful substances for several hours.

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 the blood change in a positive way, excessive viscosity is eliminated, blood supply and oxygen supply to organs and tissues are increased. This provides an improvement in the general condition of the body, increasing adaptive abilities, and also removes the symptoms of intoxication with harmful compounds.

However, rely only on plasmapheresis of blood is not worth it, since it is always important to carry out complex treatment of any disease, following the prescriptions of the doctor.

Who is shown this procedure

Now many doctors prescribe plasmapheresis. What is this procedure - most patients do not even imagine. And meanwhile, to know, under what conditions it is necessary to agree to such method of treatment, certainly, it is necessary. Plasmapheresis is a cleansing of the body, which is recommended for the treatment of diseases of almost all organs and systems of man. However, there are a number of pathologies in which plasma exchange therapy is an absolute indication. This means that the rejection of procedures can lead to the death of the patient. Such diseases include:

• Sickle-cell anemia ;
• Thrombocytosis and leukocytosis;
• Erythroleukemia;
• Porphyrin disease;
• Hypercholesterolemia (hereditary);
• Rufus disease;
• DIC-syndrome;
• Hypervisual syndrome;
• Myasthenia gravis;
• Guillain-Barre syndrome;
• Delayed thrombocytopenia;
• Myoglobinemia;
• Intravascular hemolysis;
• Goodpasture syndrome ;
• Gasser's syndrome;
• Thrombocytopenic acroangiothrombosis;
• Cryoglobulinemia;
• Chronic polyneuropathy;
• Poisoning with poisons.

Relative indications for plasmapheresis are:

• Pathology of the gastrointestinal tract: ulcerative colitis, Crohn's disease.
• Cardiovascular diseases: a condition after a heart attack, myocarditis, rheumatism, etc.
• Allergies: atopic dermatitis, pollinosis, etc.
• Dermatological diseases: psoriasis, pemphigus, herpes, etc.
• Kidney pathology: glomerulonephritis, urinary tract infection, etc.
• Diseases of the respiratory system: bronchial asthma, hemosiderosis.
• Problems with the liver: autoimmune hepatitis , etc.
• Purulent-septic complications after operations.
• Systemic vasculitis.
• Toxic lesions in cancer.
• Atherosclerosis.

Recently gynecologists advise to carry out plasmapheresis during pregnancy, if a woman suffers from toxicoses, there is a Rh-conflict or fetoplacental insufficiency. This list can be continued for a very long time. After all, there are about 200 diseases in which plasmapheresis can be successfully used. There are also contraindications to this method.

Who will have to abandon this procedure

For this procedure there are not so many contraindications. But it is strictly forbidden to conduct it in the presence of irreversible organ damage, with not stopped bleeding, impaired coagulability and gastric ulcer.

It is not recommended to cleanse the blood in violation of the rhythm and heart rate, pressure jumps, reduced blood viscosity, menstruation, acute infectious diseases, hypoproteinemia, anemia in elderly patients, various types of shock, serious liver diseases, bad veins.

Previously, it was believed that plasmapheresis during pregnancy is dangerous to the health of the child, but modern research proves the opposite. Naturally, under condition of carrying out of procedure strictly under indications and according to the instruction.

Thus, some conditions exclude the possibility of using plasmapheresis as a therapy method. Contraindications should be evaluated by the attending physician, especially if there is a risk of deterioration of the patient's health in the event of a refusal of the procedure.

How is therapy performed?

For carrying out plasmapheresis, no special preparation is required. Usually the procedure is performed in special manipulation rooms or directly in the patient's ward. For this, the patient lays down on a special couch and takes a comfortable position. Depending on the method, a special catheter (flexure) is injected into one or two arms. Most often for this use veins on the elbows. If the patient is in serious condition, then the catheter is inserted into the subclavian vein. To prevent blood clotting and clots are not formed, heparin is additionally injected into the flexure.

The procedure lasts about 1-2 hours. It depends on the method and volume of the blood being purified. During all manipulations, the patient is constantly under the supervision of a doctor. He is measured pulse, blood pressure, check breathing and oxygen supply of tissues.

Apparatus for plasmapheresis are portable or stationary. The first is much more convenient, because they can be transported to any place in the hospital or even home to the patient. The device takes the blood portionwise, about 40 ml at a time, cleans it, brings it back through the catheter and takes the blood again. Some devices use the automatic introduction of anticoagulants. For one minute, the device for plasmapheresis is able to process about 100 ml of blood, that is, in an hour approximately 800 ml of excess liquid can be removed.

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

It is known that the plasma is 55% of the bcc. And to determine the last figure, you need to multiply the body mass by 75. For example, a person weighing 80 kg in one session needs to remove the following amount of plasma:

80 x 75 x 0.55 x 0.25 = 825 ml.

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

Can plasmapheresis harm?

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

• Anaphylactic shock.
• Allergies to the donor plasma and the substituting fluids.
• Autoimmune renal damage as a reaction to donor plasma.
• Infection from the donor plasma.
• Development of sepsis in case of non-observance of asepsis rules.
• Bleeding (if there are problems with coagulability).
• Thrombosis (with insufficient use of anticoagulants).
• Falling blood pressure.
• Removing not only toxins, but also nutrients along with plasma.
• Short-term decrease in immunity.
• Disturbance of metabolism and quantity in blood of the taken preparations.
• Nausea.
• Headache.

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 they, what specialists are working there, are there any permits for 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.

What are the expected results?

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

To achieve good results, you need to be confident in the quality of care provided and undergo a preliminary examination to confirm that there is no contraindication 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 point in treatment. This should be taken into account. However, many clinics offer discounts if the duration of the course exceeds 5 sessions. It should be noted that this procedure can not be cheap because the equipment and materials are now quite expensive. Therefore, do not trust the clinics, in which the procedure is carried out at a very low price.

Let's sum up the results

Yes, this therapy painfully hits the patient's pocket, but it's worth it. Improvement of the general condition, inclusion of all protective and compensatory functions, normalization of rheological parameters of blood, removal of symptoms of intoxication - this is not the entire list of positive effects of the procedure we are considering on the body.

Plasmapheresis is an innovative technique that helps many patients cope with their ailments and cleanse the blood of "contaminated" plasma. This procedure is shown with a huge number of diseases and has very few contraindications. The implementation of plasmapheresis with the help of qualified specialists and with the observance of all instructions gives positive results in the therapy of even the most rare diseases.