Plasmapheresis – what is this procedure and when is it necessary. Benefits and harms of plasmapheresis Indications for plasmapheresis

Human blood plays great importance For normal operation the body, therefore the condition of the whole organism depends on its purity. Under the influence of negative external influence, changes associated with age, bad habits and poor nutrition, gradual contamination of the blood occurs with toxins, toxic and other substances that have a negative effect on it.

You can help your body become healthier and stronger if you periodically do blood cleansing procedures. This is precisely why the plasmapheresis procedure is performed.

You need to know that this method of healing cannot be carried out independently. All procedures must be performed only in a medical facility and only by highly qualified specialists. And also, before deciding on such treatment, you can consult with a doctor who has already performed such “operations” more than once.

Pros and cons of plasmapheresis

The plasmapheresis procedure involves the process of removing plasma from the blood. After this, the plasma is filtered. Then all the necessary elements are taken from it, which renew the blood and are reintroduced into the human body. Of the volume of blood fluid that was taken, only 25% ends up in the filter. In order to complete the entire volume, add saline solution.

Benefits of the procedure

As already said, plasmapheresis should be performed in a medical clinic and by experienced doctors. Another condition is that the procedure is carried out using materials that have undergone thorough sterilization and using disposable instruments.

Before performing the “operation” of plasmapheresis, the specialist performing such treatment must carry out an individual calculation of the volume of blood required for cleaning. Therefore, the attending physician requires information about the patient’s height and weight, as well as information about preliminary studies completed.

During blood collection and plasma injection into the body, the person is monitored by medical personnel. At the same time, with the help of devices, the state of pulse and pressure is constantly monitored, as well as how fast the patient’s breathing is.

During the “operation” itself, the patient is monitored by medical personnel who have experience in performing these procedures. Special equipment is also attached to the patient, which monitors the condition of the body. Devices are also connected to the patient to monitor how oxygenated the blood is and the breathing rate.

Another advantage of plasmapheresis is painlessness. For this purpose, no painkillers or medications of this type are used. Taking and administering blood is absolutely easy. In addition to the collected and processed plasma, only saline solution and drugs that replace blood fluid are injected into the human body.

Blood renewal has overall effect on the human body. After the procedure, changes in health occur.

Immunity increases.
The consistency of the blood becomes more liquid, which prevents heart disease.
The amount of cholesterol decreases.
The pressure becomes stable.
Metabolism is restored.
The possibility is excluded oxygen starvation.

It is very important that the plasmapheresis procedure is carried out according to all the rules. Since any violation can cause complications.

Side effects

After the patient's blood has been renewed, he may experience minor negative effects, expressed in symptoms:

blurred vision periodically occurs in the eyes;
slight dizziness;
pressure in the arterial system may decrease.

As a result of plasmapheresis, substances such as immunoglobulins are removed. This happens when plasma is removed from the blood. But still, this does not affect the immune system.

Results of one session

As a result of the session, almost 20% of those harmful substances that negatively affect health. But if the patient has a fairly severe form of any disease, then such treatment may be ineffective.

For a more effective result, it is necessary to carry out a complex, including a number of therapeutic procedures and strict diets that help strengthen the health of the entire body.

For whom is this procedure necessary?

Blood cleansing is not possible for every disease. Among the many human diseases there are about two hundred. It is for these diseases that this procedure is most effective and permissible.

Such diseases include disorders of certain body systems, as well as its reaction to any injury. In most cases, it is the doctor who determines whether this procedure is possible and necessary. Diseases for which blood cleansing is prescribed include injuries skin caused by an allergic reaction, inflammatory processes, or burns.

The “operation” is considered to be most effective if there is an infection in the human body, or with diseases such as periodontal disease, chlamydia, or with serious forms of poisoning.

Very often, this procedure is prescribed to women who are planning to conceive a child. Because, for normal development The fetus needs to ensure that there are no toxins in the mother’s body. This is especially useful for women who smoke, drink alcohol, have used drugs, or medications containing toxins.

It is also advisable to carry out blood cleansing for pregnant women suffering from allergies or for the purpose of its prevention. Indications for this method treatment is considered:

the presence of a chronic infection in the body;
autoimmune diseases;
Rhesus conflict that has arisen.
In what cases is plasmapheresis contraindicated?

It is strictly forbidden to carry out the plasmapheresis procedure in case of heavy bleeding, especially if you can’t stop him. Before the “operation”, tests are taken from the patient, which, after examination, reveal the presence of contraindications. It is not advisable for a patient to perform blood cleansing if he:

poor coagulation of blood fluid was revealed;
pressure too low;
cardiac dysfunction;
have serious illnesses;
a small amount of protein was found in the blood;
there is an infection in the body;
underdeveloped veins.

If the patient is female, then plasmapheresis is prohibited during the menstrual cycle, since during this period the patient already loses blood, which is renewed independently.

In the event that there is any contraindication, then he simply must consult a specialist. Since this “operation” may not only not give the desired result, but also completely negatively affect the patient’s condition.

How is blood purified?

This procedure is one of the most popular methods of blood purification. Medical personnel perform this “operation” in six stages.

First, blood is drawn.
After this, the blood is separated into its constituent elements.
Next, the substances obtained as a result of processing are reintroduced into the bloodstream.
The missing amount of plasma is replaced with a special saline solution.
Plasma that has been processed or that was taken from the patient is added to it.
The fluid obtained as a result of this entire process is reintroduced into the body.

Additional plasma treatment services are also provided. However, this can only be done in cases of an individual approach.

The process is executed only if there is medical clinics special devices and apparatus. The patient must lie down during each procedure.

Blood fluid is removed from the body using one or two needles. The devices used in this procedure must be large, much larger than the needles that are inserted into the veins when connecting the IV.

Fractions are separated by three methods.
Filtration or membrane.
Centrifugal or gravity.
Cascade.

First method

The blood fluid that was taken from the patient is filtered in devices created for this procedure. When the entire stage is completed, the resulting substances are introduced into the patient’s blood, but the plasma substances are destroyed or further filtered. The same applies to cells that have not undergone treatment.

Second method

The collected blood is placed in bags, which are then sent to a centrifuge. The formed element settles in the apparatus. The blood is divided into cell masses and plasma. The plasma is subsequently removed from the bag and the resulting elements are reintroduced into the bloodstream.

Third method

The collected plasma is filtered in a special device. During the filtration process, the plasma passes through an additional filter insert, which allows only low molecular weight proteins to pass through.

Last stage of the procedure

The final stage consists of returning the processed formed elements to the patient by introducing them into the blood. Since these elements are quite dense, the lack of plasma, which dilutes the liquid, is replaced with saline solution or solutions that can replace blood. It is also possible to return your own plasma, but only after it has undergone additional filtration. When a patient has a plasma pathology, then the patient is injected with donor plasma, which is enriched with the protein fraction.

What method will be used for fractional separation, what composition will be used and in what volume the solution will be processed, the amount of plasma that needs to be removed is decided on an individual basis.

Blood can be divided into two components: liquid and cellular. The cellular component is represented by the formed elements of blood (erythrocytes, leukocytes and platelets), and the liquid component is represented directly by plasma, which consists of protein and saline solutions, there are also compounds present that are dangerous to the body.

The plasmapheresis procedure has a pronounced healing effect: when part of the plasma is removed, the harmful substances that caused a particular disease also leave the patient’s body. Such “pests” are considered to be cholesterol, uric acid, pathological proteins, and protein breakdown products. The affected organs and their systems will begin to function better as soon as the quality of the patient’s blood increases. In addition, one more positive side of plasmapheresis can be noted: as a result of mechanical purification of the blood from harmful toxins, the body forms a response - mobilizes its defenses.

Most often, plasmapheresis is included in the composition complex therapy, since its use as an independent procedure does not always produce visible results, and the effect does not last long. The method of mechanical blood purification is usually combined with such therapeutic procedures, which partially prevent the saturation of the blood with toxins, the formation of dangerous compounds in the body itself, and also stimulate their unhindered elimination from the body.

Methods of carrying out the procedure

At one time, approximately ¼ of the total volume of blood plasma is removed from the human body. All plasma takes up a little more than half of the blood, while the volume of the blood itself depends on how much the patient weighs. Thus, in a patient weighing 70 kg, approximately 700 g of blood plasma will be removed during the plasmapheresis procedure. The number of sessions is determined by the diagnosis and severity of the disease, but generally ranges from 2 – 3 to 12 sessions.

There are several ways to extract plasma from blood:

Filtration. Using a special filter, cellular and plasma components are isolated from the blood. Next, the cellular part is diluted with a 0.9% sodium chloride solution and returned to the body, the plasma component is removed.
Gravitational. The patient donates 0.5 liters of blood from a vein into a special container, which is then sent to a centrifuge. The blood cells settle there and are later returned to the patient’s body as part of a saline solution. To achieve a therapeutic effect, it is necessary to conduct at least 3 sessions of gravitational plasmapheresis.
Plasmasorption. This version of plasmapheresis is not based on the extraction of plasma, but on its purification from the blood. It is used as a special sorbent for the cleansing procedure.

If indicated, all methods of mechanical blood purification can be supplemented with a procedure during which blood cells are irradiated with ultraviolet light.

Indications for blood purification through plasmapheresis

The list of pathologies for which plasmapheresis is indicated for a patient is very extensive, and MirSovetov once again reminds that persistent positive effect after such a cleansing procedure, it is observed only in combination with other therapeutic methods. It is advisable to use mechanical blood purification for the following diseases and conditions:

multiple myeloma;
massive destruction of red blood cells inside the vessels;
free myoglobin in the blood;
hemoglobinopathy;
intoxication with poisons of chemical origin;
porphyria;
myasthenia gravis;
Gasser's disease.

Mechanical blood purification also has a beneficial effect on the patient with the following diseases:

viral myocarditis;
chronic pneumonia;
ulcerative colitis;
diabetes;
nettle rash;
endocrine diseases of the organs of vision;
glomerulonephritis;
encephalitis caused by allergies;
systemic vasculitis;
rejection of a transplanted organ;
extensive burns;
acute peritonitis;
sepsis.

Contraindications to the procedure

Unfortunately, even such a useful, at first glance, procedure as plasmapheresis has side effects. The point is that the blood plasma also leaves the body with substances useful to the body: proteins (including immunoglobulins) and components of the blood coagulation system (prothrombin, fibrinogen). On this basis, blood purification is not carried out if the patient is diagnosed with low level protein in the blood, as well as when there is a high probability of bleeding (usually occurs if the liver is severely damaged).

Contraindications to plasmapheresis are divided into absolute and relative.

Absolute contraindications include serious damage vital important organs(brain, heart, lungs, kidneys or liver), massive bleeding.

Relative contraindications include high bleeding and a high risk of bleeding due to various diseases(for example, the duodenum), lack of stability in the circulatory system (hypotension), low concentration protein in the blood, diseases infectious origin, pregnancy and menstruation.

We list the absolute contraindications to plasmapheresis:

Overload of cardio-vascular system(particularly the right side of the heart).
Pathological death of cerebral vessels due to impaired cerebral circulation.
Excessive increase in blood pressure.
Drug addiction and other neuropsychiatric disorders.
The blood is too thick.
Acute or chronic dysfunction liver.

A blood purification session in the presence of the listed diseases can result in death for the patient.

The issue of using plasmapheresis to relieve a patient from alcohol addiction. Although this procedure can be used to remove blood from the blood, after some time a withdrawal syndrome inevitably develops, expressed by some kind of neuropsychiatric disorder, disruption of the cardiovascular system, cerebral edema, and liver dysfunction. In a word, using plasmapheresis in the treatment of drug addiction patients is inappropriate and dangerous for the patients’ lives. Alcoholism and drug addiction respond well to xenotherapy.

Possible complications of the procedure

As practice has shown, the human body, which has no contraindications to plasmapheresis, can react to this method of blood purification in a completely unpredictable way. Here are the complications that patients experienced as a result of treatment:

Anaphylactic shock. Allergic reaction manifested by chills, various autonomic disorders, hemodynamic disorders and leads to death in 60% of cases.
Hypotension. Blood pressure drops sharply, which leads to a lack of oxygen in the brain. About 60% of cases result in lifelong disability or death.
Extensive bleeding (with erosion and ulcer of the gastrointestinal tract), which is sometimes extremely difficult to stop, so the patient is urgently resuscitated. Isolated deaths were recorded.
Citrate intoxication. It does not happen often - the patient falls into a coma and dies.

Special preparation before the procedure of mechanical blood purification is not provided, just as there are no special recommendations after it has been carried out.

, ). Depending on the purpose, there are 2 types of procedures:

Therapeutic plasmapheresis– consists of separating plasma from blood cells in order to remove plasma containing toxins, allergens, autoantibodies... In this case, the formed elements are returned back into the bloodstream, and the plasma is utilized. This procedure allows you to reduce the concentration of some toxic elements (poisons, toxins, allergens, antibodies...) in the human body. Thus, this is one of the types of detoxification therapy.
Donor plasmapheresis– also involves the separation of plasma from blood, but the procedure is carried out healthy people(donors), and the resulting plasma is preserved for subsequent transfusion or the creation of blood products.

Types of plasmapheresis depending on the method of plasma separation:

Sedimentation - separation of plasma occurs due to sedimentation. At the same time, blood cells gradually precipitate.
Centrifugal - the separation process is accelerated due to 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 allow plasma to pass through, but not blood cells.
Cascade - in in this case The already obtained blood plasma is re-passed through a special filter, which allows only low-molecular-weight blood proteins (albumin) to pass through and retains high-molecular-weight ones (lipoproteins).

Indications for plasmapheresis:

exogenous intoxications:

food poisoning;
overdose medicines;
consequences of chemotherapy;

endogenous intoxications - 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;

blood diseases:

multiple myeloma;
macroglobulinemia;
paraproteinemia;
thrombocytopenic purpura;
monoclonal gammopathy.

amyloidosis;
in combination with severe atherosclerosis;
donation

Contraindications to plasmapheresis:

Absolute:

continued bleeding;
blood clotting disorder.

Relative:

risk of bleeding, for example, peptic ulcer of the stomach and duodenum; if a decision is made about the need for plasmapheresis, the procedure is carried out without the use of heparin;
unstable hemodynamics;
hypoproteinemia;
acute infectious processes;
menstruation.

Myths and misconceptions

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

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

It is important to understand that plasmapheresis “does only what it does” - it reduces the concentration of certain substances in the blood. It does not prevent their formation in the body, does not eliminate the cause, and in most cases is used only in complex therapy. Thus, its implementation is indicated only when there is an increase in the blood of one or another substance that negatively affects the body, and the risk of complications from the procedure does not exceed the risks associated with the underlying disease.

In a situation where traditional drug treatment a number of pathologies does not lead to the desired result, does not improve the patient’s condition, methods of efferent therapy (or extracorporeal detoxification) come to the rescue, the main one being plasmapheresis. The essence of this intervention is to remove part of the patient’s blood from the bloodstream, remove toxic and other substances unnecessary for the body, and then return it back to the bloodstream.

There are 2 main types of plasmapheresis – donor and therapeutic. The essence of the first is to collect plasma from a donor and then use it for its intended purpose. The second is carried out to treat a number of different diseases. It is about therapeutic plasmapheresis - its types, indications and contraindications for use, the methodology for carrying out the procedure, as well as possible adverse reactions and complications that will be discussed in our article.

Why does the body need blood?

Blood is one of the organs of the human and animal body. Yes, this organ is liquid and circulates through special vessels, but its health is no less important for the body than the health of the liver, heart or other structures of our body.

Blood consists of plasma and formed elements (erythrocytes, leukocytes, platelets), each of which performs specific functions. Blood also contains various substances dissolved in it - hormones, enzymes, coagulation factors, proteins, circulating immune complexes, metabolic products and others. Some of them are physiological for the body, while others (for example, cholesterol) lead to the development of diseases.

Plasmapheresis will help rid the blood, and therefore the entire body, of substances dangerous to its health.

Effects of plasmapheresis and types of procedure

Plasmapheresis is not magic, it is not capable of restoring youth to the body and healing it from all diseases, however, the effects that this procedure has alleviate the course of some diseases and undoubtedly improve the patient’s condition.

During a plasmapheresis session, part of the plasma is irretrievably removed from the bloodstream. Along with it, various pathogenic substances are also removed, for example, toxins of bacteria, viruses, circulating immune complexes, breakdown products of red blood cells, cholesterol, metabolic products and others.
Before blood cells are returned to the bloodstream, they are diluted with saline, glucose and blood substitutes to the required volume. This improves blood flow and reduces the risk of blood clots.
As a result of the removal of a certain volume of plasma, many physiological reactions of the body are activated, and its resistance to the effects of adverse environmental factors increases.

As for classification, plasmapheresis is primarily divided into non-hardware and hardware. Non-hardware methods do not involve the use special devices. They are quite simple and financially accessible to many, but they allow only a small volume of blood to be purified and carry an increased risk of infection and other complications. Hardware plasmapheresis is carried out using special devices. Its leading methods are:

filtration, or membrane (blood passes through special filters that pass its liquid part - plasma and retaining formed elements);
centrifugal (the patient’s blood enters a centrifuge, as a result of the rotation of which the blood plasma and its formed elements are separated from each other; the cells are immediately mixed with blood substitute solutions and returned to the bloodstream);
cascade, or double filtration plasmapheresis (this method involves passing blood through filters 2 times; the first retains cells, and the second - large molecules).

Another type of this procedure is cryoplasmapheresis. The blood is filtered, the separated plasma is frozen at -30 ° C, during the next session it is heated to +4 ° C, centrifuged, and then reintroduced into the patient’s body. This method allows you to preserve almost all of the plasma protein, but it is used only under strict indications.

Indications and contraindications for plasmapheresis

Before prescribing plasmapheresis, the doctor examines the patient and weighs everything possible indications and contraindications to the procedure.

This procedure should not be the initial and only method of treatment. It is used only in combination with medication and other treatment options, and then only when these methods have exhausted themselves and have not led to any positive result.

Indications for plasmapheresis are:

diseases of the cardiovascular system (viral, autoimmune, rheumatic lesion heart disease, systemic vasculitis, atherosclerosis and others);
pathology of the respiratory system (Wegener's granulomatosis, fibrosing alveolitis, hemosiderosis, and so on);
diseases of the digestive tract ( Crohn's disease,
, hepatic encephalopathy and others);
diseases endocrine system(, adrenal insufficiency);
illnesses urinary tract(autoimmune glomerulonephritis, severe pyelonephritis, cystitis and others infectious diseases, chronic renal failure, Goodpasture's syndrome, secondary kidney damage in systemic diseases connective tissue);
systemic connective tissue diseases (dermatomyositis, scleroderma, systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis and others);
skin pathology (herpes, toxicoderma);
diseases of an allergic nature (acute or chronic urticaria, Quincke's edema, hay fever, heat, cold allergies and others);
diseases nervous system(chronic infectious diseases, and others);
eye diseases ( diabetic retinopathy and others);
poisoning by various chemicals at work and at home, including drug overdose;
hangover syndrome;
during pregnancy – fetoplacental insufficiency, maternal diseases of an autoimmune nature, Rh conflict.

In some cases, plasmapheresis is categorically not recommended. Absolute contraindications to this procedure are:

ongoing bleeding;
severe brain diseases (and others);
cardiac, hepatic, renal failure in the decompensation phase;
acute neuropsychiatric disorders.

There are also relative contraindications, that is, those conditions that it is desirable to eliminate (compensate) before plasmapheresis, but in case of urgent need, solely by the decision of a specialist, this procedure can be performed with them. These are:

disorders in the blood coagulation system;
hypotension (low blood pressure);
heart rhythm disturbances;
ulcerative damage to the digestive tract (stomach, intestines);
reduced protein content in blood plasma;
acute infectious diseases;
period of menstruation in women.

Plasmapheresis in these conditions is associated with increased risk their aggravation - the development of more severe cardiac arrhythmias, lowering blood pressure, bleeding, and so on. In such situations, the doctor should pay increased attention on the patient’s condition and take actions to stabilize it.

Do I need to get examined?

In essence, plasmapheresis is surgery, for which there are both indications and contraindications. In order to detect these conditions, before starting a course of treatment with this method, the patient must undergo an examination. It includes:

examination by a therapist or other doctor, including measurement of blood pressure and assessment of other important indicators body work;
clinical blood test (to promptly diagnose acute or chronic inflammatory process or other serious diseases);
a blood test for glucose (included in the list of mandatory examinations for every patient; it allows diagnosing diabetes mellitus, and in those with a confirmed diagnosis, monitoring blood sugar levels);
coagulogram (to assess the parameters of the blood coagulation system, detect a tendency to form blood clots or increased bleeding);
a blood test for the Wasserman reaction, or RW (this is also a mandatory diagnostic method that allows you to detect or exclude such an unpleasant pathology as syphilis);
biochemical blood test to determine the level of protein fractions in it (allows you to diagnose hypoproteinemia, which is relative contraindication for plasmapheresis sessions);
ECG (allows you to evaluate the work of the heart).

At the discretion of the doctor, the patient may be prescribed other examination methods that confirm the need for plasmapheresis or, on the contrary, exclude this method of treatment for a particular patient.

Methodology

Plasmapheresis is one of the options for surgical intervention in the human body. That is why it should be carried out not just anyhow, not during a lunch break, but after a full examination, in specially equipped rooms, in conditions similar to those in the operating room.

During the procedure, the patient is in a lying or reclining position on his back on a regular couch or in a special chair. A needle or a special catheter is inserted into his vein (usually in the elbow area), through which blood is obtained. Most modern devices for plasmapheresis provide for the installation of needles in 2 arms at once - through the first, blood will leave the body and enter the device, and through the second, it will simultaneously return to the bloodstream.

As described above, blood passing through the apparatus different ways is divided into fractions - plasma (liquid part) and formed elements. The plasma is removed, the suspension of blood cells is diluted with saline, solutions of glucose and potassium chloride, rheopolyglucin, albumin or donor plasma (by the way, it is used for this purpose very rarely and according to strict indications) to the required volume and injected back into the patient’s body.

1 session lasts from 1 to 2 hours. This depends on the plasmapheresis method used and the patient’s condition. The amount of blood “driven” through the device in 1 session also varies and is determined individually by calculating special computer programs and a specialist who prescribes and carries out treatment.

The entire time plasmapheresis is performed, the doctor remains next to the patient, carefully monitoring his general condition and well-being, monitoring blood pressure, pulse rate, blood oxygen saturation level, and others. important parameters the functioning of his body. If complications develop, he, of course, provides assistance to the patient.

How many plasmapheresis procedures a particular patient needs is determined individually. The course of treatment depends primarily on the disease that is supposed to be treated with this method, as well as on the individual reaction of the patient’s body to treatment. As a rule, it includes from 3 to 12 sessions.

Complications

With a professional, responsible approach of the specialist performing plasmapheresis to his work, with full examination patient, when using modern high-quality equipment, procedures are tolerated well by patients, and unpleasant situations occur extremely rarely. However, since each organism is individual, it is impossible to completely predict its reaction to plasmapheresis - in some cases complications still develop. The main ones are:

allergic reactions up to anaphylactic shock(as a rule, they develop in response to the introduction into the bloodstream of donor plasma or drugs that prevent the formation of blood clots);
hypotension ( a sharp decline blood pressure; occurs in cases where a large volume of blood is simultaneously removed from the patient’s bloodstream);
bleeding (develops as a result of exceeding the dose of drugs that reduce the ability of blood to clot);
the formation of blood clots (they are a consequence of an insufficient dose of the above drugs; blood clots spread with the blood flow and, entering vessels of a smaller diameter, clog them; these conditions are extremely dangerous for the patient’s life);
blood infection (occurs when the rules of asepsis are violated during plasmapheresis, more often with non-hardware methods of this procedure, but with hardware - extremely rarely);
renal failure (can develop if donor plasma is used as a blood substitute; it is a consequence of the latter’s incompatibility with the blood of a person receiving plasmapheresis).

Conclusion

Plasmapheresis is one of the efferent medicine methods most commonly used today. During the procedure, the patient’s blood is removed from his bloodstream, enters the apparatus, where it is divided into 2 fractions - liquid (plasma) and formed elements. The plasma with the pathological substances it contains is removed, and the blood cells are dissolved with blood substitutes and returned to the bloodstream.

This method of treatment is auxiliary, used only when other methods have proven ineffective, and complements them. Many people believe that plasmapheresis is an almost magical healing technique that will rid the body of problems that have accumulated in it for decades, and can even be used as a preventive method. Unfortunately no. There are certain indications for it, and your doctor is unlikely to recommend it to you if other, non-invasive treatment methods have not yet been tried. Still, plasmapheresis is a surgical intervention that requires certain preparation and can lead to the development of complications.

However, when carried out according to indications, plasmapheresis is very effective and can significantly improve the patient’s condition in just a few sessions.

TVK, experts talk about plasmapheresis:

Plasmapheresis- This is a blood purification technique. You can compare it with bloodletting, but carried out in a more humane and modern methods. Just a few decades ago, the procedure was carried out practically manually, and, naturally, it was impossible to achieve complete sterility. Attempts to separate blood plasma for purification purposes have been carried out by scientists since the beginning of the twentieth century. But in those years, the duration of the procedure was long, the equipment for carrying it out was enormous. Therefore, use it in medicinal purposes didn't. And only seventy years later, devices were developed that could effectively and quickly extract plasma from the blood.
Since the nineties, the technique has become very popular in Russia.

Principle of the technique

The principle is that a small portion of blood is removed from the body, which passes through a machine that separates the blood into plasma, white blood cells, red blood cells, and platelets. The plasma is removed, and the formed elements are returned to the body. Sometimes the plasma is treated with cold, a process called cryoapheresis.
There are two ways to purify plasma - using gravity and using special filters. They are, respectively, called gravitational and filtration. In the first case, the blood is passed through a centrifuge, in the second through porous membrane filters.

Kinds

hardware,
centrifugal,
membrane,
sedimentation.

For these varieties they use different ways separation of plasma from blood.

Membrane plasmapheresis– toxic substances and ballast cells are removed from the blood. To do this, the plasma is distilled through special filters. This is enough effective method treatment of many diseases in which changes internal environment human body. It is impossible to normalize it with the help of medications. Such diseases include:

extensive burns,
acute inflammation internal organs,
severe infections,
immune distress syndrome.

The use of this technique allows you to quickly achieve good treatment results and reduce the likelihood of death.
Cleansing the blood of immune cells eliminates the manifestations of autoimmune diseases. Cleansing excess fats facilitates the course of atherosclerosis. This technique helps alleviate the patient's condition after chemotherapy or radiation. It is very effective for drug addiction, Rhesus conflicts in pregnant women, urogenital infections, and recovery from viral hepatitis. Plasmapheresis can reduce the likelihood of secondary complications of diabetes.

Cascade plasmapheresis- This is the passage of plasma through a special filter with very small pores. This procedure cleanses the plasma of large molecules of proteins and fats. Developed by the Japanese in 1980. Today it is widely used in the treatment of atherosclerosis with an increased amount of lipids in the blood, to prevent heart attack, aneurysm, stroke. The cascade technique also shows very good results for autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, Crohn's disease, ulcerative colitis, thrombotic purpura, myeloma and many others.

Donor and treatment

Plasmapheresis can be donor, that is end result The procedure involves collecting plasma from a donor. This procedure and the amount of biomaterial collected is strictly regulated by donation laws. As a result, blood is removed from the donor’s body, passed through the machine, the formed elements are poured back, and the plasma is stored.
At medical procedure up to 30% of the patient's blood can be processed at one time. It is removed from the body in portions, passed through the apparatus and poured back in purified form.

Indications

Plasmapheresis should not be considered as health treatment, which can be done by everyone. This is a treatment that is prescribed as an additional auxiliary method when the main treatment does not produce the desired effect. The procedure is prescribed for more than two hundred diseases.

Indications:

oncological diseases,
atherosclerosis,
angina pectoris
myocardial infarction,
arterial hypertension,
trophic ulcers of the gastrointestinal tract,
Crohn's disease,
nonspecific ulcerative colitis,
hepatitis,
possibility of hepatic coma,
glomerulonephritis with nephrotic syndrome,
arterial hypertension not amenable to medication,
uremic itching,
septic shock during purulent processes,
prevention of acute renal failure due to prolonged compartment syndrome,
rheumatoid arthritis,
diabetes,
some gynecological and obstetric pathologies,
dermatological diseases.

Contraindications

Absolute contraindications:

stomach ulcer or duodenum with bleeding,
blood clotting disorder.

Relative contraindications:

anaphylactic, traumatic and other types of shock,
severe liver diseases, acute infectious hepatitis,
anemia in patients over 70 years of age, combined with heart disease,
poorly defined peripheral venous network.

How is the procedure done?

The duration of the procedure is about 90 minutes. It does not cause any discomfort to the patient. The patient lies down in a special chair, and catheters are inserted into the veins of both arms. Then you can watch TV ( if it is in the clinic) or listen to music. The device does the rest. Throughout the procedure, the patient’s condition is monitored: his pulse, blood pressure, breathing and the presence of oxygen in the blood are measured.

During a session, from 25 to 30% of the blood is cleansed, and therefore at least three procedures should be done to complete cleansing. The doctor calculates the amount of blood purified in one session individually, based on the patient’s body weight, age and general condition body.

Since blood purification is not such a simple procedure, after it the patient will have to spend 30 to 60 minutes under the supervision of a doctor. When the patient's condition stabilizes, he is sent home.
No preparation is required for the procedure. Just like you don’t need to follow any special recommendations after plasmapheresis. Although, in some cases, doctors give special advice.

What devices are used?

Plasmapheresis devices are either stationary or portable. With the help of the latter, you can carry out the procedure even at the client’s home. Modern devices take small portions of blood and purify them one by one. Convenience portable devices the fact that they can be transported within the hospital and installed near the patient’s bed without transferring him to another room.
The portion of blood taken is only 40 milliliters, the valve stops the blood flow. It is cleansed and returned to the body. After which a new portion of blood is taken. Therefore, patients do not feel any discomfort at all.
In a minute, a good device can clean and return up to 100 milliliters of blood to the patient’s body. In this case, up to 800 ml of plasma can be obtained per hour. To prevent blood clotting, some methods use anticoagulants, which are administered automatically in portions.

Without a break, the device can work up to 10 hours.
There are devices equipped with two catheters: blood is withdrawn through one, and returned through the other.
The device uses approximately 75 watts per hour.
The plasma obtained using the devices fully complies with all standards and is ready for use.

Side effects

In general, the procedure was very well tolerated. In very rare cases, mild nausea or a migraine-like condition may occur. However, these undesirable effects go away very quickly on their own.
The procedure can be dangerous only for patients with poor blood clotting - bleeding may develop. During blood treatment, anticoagulants are added to prevent it from clotting. Such an additive in case of poor clotting can lead to the fact that the blood will not clot at all.

Hardware and discrete – type of donation

The procedure of hardware plasmapheresis is aimed at collecting blood plasma from a donor. During the procedure, a catheter is inserted into the donor's vein, the tube from which is connected to the device. In the device, the collected blood is divided into the “thick” part and plasma. The first is sent back to the donor's body, the second is preserved. With this method, much less blood is taken than with the discrete method. This is from 50 to 300 milliliters.
Discrete plasmapheresis involves removing blood into a sterile container ( no different from standard blood sampling from donors), after which it is sent to a centrifuge. The formed elements are poured back into the donor's body, and the plasma is taken for preservation. During this procedure, up to 0.4 liters of blood or 0.3 liters of plasma can be taken at a time. Instead of plasma removed from the body, saline solution is infused. If a double procedure is performed, then 2 portions of plasma are removed from the donor’s body - up to 0.6 liters.

Hemosorption

Both plasmapheresis and hemosorption are used very widely to detoxify the body.
Hemosorption is the purification of blood using sorbents. Sometimes both methods are prescribed in combination. They usually complement drug treatment.
If plasmapheresis better corrects the level of immune cells in the body, and also effectively has a positive effect on the rheological properties of the blood, then hemosorption very effectively cleanses the blood of toxins of any origin.
Hemosorption is prescribed for acute or chronic endotoxicosis, autoimmune diseases, disorders of the rheological picture of the blood, poisoning with barbiturate, certain drugs, poisons, and liver diseases that cause intoxication.
As an auxiliary method of treatment, it is prescribed for systemic lupus erythematosus, bronchial asthma, psoriasis, cold urticaria, and nutritional allergies.
The sorbent for hemosorption is most often activated carbon, as well as ion exchange resins. However, resins usually have a narrower spectrum of action: a certain resin for certain type poisons

For psoriasis

For patients with psoriasis, plasmapheresis is prescribed when the disease occurs in exudative form, as well as with erythroderma. It should not be used as the only treatment as it is ineffective.
Treatment of psoriasis with plasmapheresis occurs in two stages.
The first stage: this is a course of plasmapheresis, which provokes activation of the disease - this is the reaction expected by doctors to obtain the “rebound phenomenon”.
Further procedures will lead to a rapid decrease in disease activity. As soon as the number and intensity of the rash decreases, exudative reactions pass, the second stage of treatment begins. Now you need to resort to methods such as phototherapy, ultraviolet irradiation, use of a number of drugs ( cytostatics or retinoids of synthetic origin).
For psoriasis, 7 to 10 sessions of plasmapheresis are prescribed at intervals of one to two days. Up to a liter of blood is cleansed per session. It is imperative to simultaneously use other methods of treating the disease. The combination with hemosorption is very effective ( up to 2 procedures). In this case, you can reduce the number of plasmapheresis to four.

For hepatitis

Hepatitis therapy IN And WITH with the help of medications it can last more than a year. However, it is quite expensive and does not guarantee complete elimination of the virus from the body. In addition, drug therapy necessarily causes side effects. The use of immune stimulants can lead to autoimmune processes. And many patients do not respond to drug treatment at all, experiencing a worsening of their condition.

Increase effectiveness drug treatment possible using plasmapheresis. During the procedure, the body is cleansed of a significant amount of immune complexes, autoantibodies, viruses in combination with fats. The procedure allows you to eliminate inflammatory phenomena in blood vessels and the disruptions they cause to the kidneys, skin, nerves, and joints. Elimination of autoantibodies makes it possible to stop autoimmune processes and stops the destruction of liver tissue.
At chronic form diseases from 3 to 5 sessions of plasmapheresis free the blood from antibodies and stop the exacerbation. The level of antibodies gradually increases in the blood and at a certain level an exacerbation develops. If you maintain the amount of antibodies, exacerbation will not occur. It is advisable to carry out a course of treatment once a year, which delays the onset of exacerbation by a year.

For gout

For gout, plasmapheresis is prescribed together with hemosorption. A sorbent is used that deposits uric acid present in the blood onto its surface. Methods are prescribed for exacerbation of the disease.

Indications:

increased values of ESR and leukocytes,
meaning uric acid more than 200,
exacerbation of the disease, combined with inflammation, redness, and swelling of the joints.

A course of three to five sessions is prescribed, which are carried out until the patient’s condition improves. In order to recover completely, avoid exacerbations, eliminate the deposition of kidney stones and achieve elimination of tophi, you should undergo plasmapheresis and hemosorption procedures for several years at intervals of 21 days for 12 months. Treatment should be combined with medication and control of uric acid levels. Its indicators should not be higher than 220 mgd.

The effect of the procedures is to reduce the amount of uric acid to 200 mgd, the complete absence of exacerbations, and the elimination of tophi and conglomerates in the kidneys.

Treatment of alcoholism

Indications for use in narcology:

therapy of chronic and acute alcohol intoxication,
intoxication developing against the background of diseases of internal organs ( cirrhosis, pancreatitis, hepatosis, hepatitis).

The use of plasmapheresis can increase the body's immunity and reduce the duration of patient treatment in a drug treatment clinic. Its effectiveness is explained by the state of the immune status, improvement metabolic processes, activation of blood circulation and oxygen in cells.

Plasmapheresis enhances the effect medications, which means reducing their number and harmful effects on the liver. The functioning of the immune system improves. The likelihood of complications of the disease is reduced: mental disorders, degenerative processes in the tissues of the heart muscle. General health the patient is relieved for short term, which allows you to quickly begin rehabilitation.

Procedures are prescribed only by the attending physician, depending on the patient’s condition. Plasmapheresis is especially indicated for people who abuse alcohol, since their liver is not able to cleanse the body of toxic substances that enter from the outside. The liver is designed in such a way that it acts in lobes. It is divided into 50 shares, each of which comes into play in its turn. If some, or all, parts are contaminated, the next cycle begins, but earlier than expected, and the organ no longer works as efficiently. To cleanse the body, a plasmapheresis procedure is required.

For allergies

Blood purification procedures significantly reduce allergy symptoms. Moreover, plasmapheresis cleanses the blood of immune complexes, metabolic products, and foreign aggressive substances, which inhibits the body’s sensitization reaction.
The mechanisms of allergy occurrence themselves are influenced. The sensitivity of adrenergic receptors, as well as the body, to drugs increases. The activity of immune bodies, in particular T-lymphocytes and alveolar macrophages, is normalized. Plasma withdrawal accelerates the release of fresh blood components, regulates the process of fat peroxidation, and enhances the activity of antioxidant mechanisms. Thus, inflammation of an immune nature is relieved, the condition of the bronchial tree is normalized, and bronchial obstruction is eliminated.

The effect of such a procedure is quite long-lasting. New blood elements arriving after cleansing retain all their qualities for a fairly long period. However, unfortunately, it is impossible to completely guarantee a cure even with the help of plasmapheresis.
It is recommended to combine procedures with medications.
Usually, after three to five procedures, the manifestation of allergies is significantly reduced or completely disappears. If a person has a lifelong allergy, its symptoms become less noticeable.

In gynecology

Plasmapheresis is prescribed for generalized infections, inflammation spreading to nearby organs, and recurrent forms of infections. This method of treatment can be quite effective for infections that are not destroyed by antibiotics, as well as for individual contraindications to the use of antibiotics.
Procedures enhance the effect medicines, reduce the likelihood of acute diseases becoming chronic, and lengthen the intervals between exacerbations in chronic processes.

The use of plasmapheresis in gynecology is indicated for the following conditions:

for the prevention and treatment of toxicosis at various stages of gestation,
to prevent Rh conflict between the mother’s body and the fetus,
with systematic miscarriages against the background antiphospholipid syndrome and DIC syndrome,
for the treatment of herpes and cytomegalovirus during pregnancy and preparation for conception,
with placental insufficiency,
to inhibit ovarian hyperstimulation syndrome,
during treatment unpleasant symptoms during menopause and severe premenstrual syndrome,
during pregnancy against the background serious illnesses (asthma, diabetes, pyelonephritis),
for infertility caused by chronic inflammation,
for complications after childbirth or after a miscarriage,
as a restorative procedure after surgical interventions on the pelvic organs,
for the prevention and treatment of bleeding,
for the prevention and treatment of multiple organ failure.

During pregnancy

Plasmapheresis is prescribed both at the stage of preparation for pregnancy as a prophylaxis, and in therapeutic purposes. The procedure is highly recommended for expectant mothers who smoke to remove poisons that accumulate in the blood from cigarettes. If a woman experiences toxicosis during pregnancy, two procedures are enough to significantly improve her condition.
According to statistics, mothers with placental insufficiency and severe toxicosis are more successful in carrying and giving birth healthy baby using plasmapheresis. Doctors manage to “hold out” until the normal delivery date. Only 25% of children in risk groups are born prematurely.

The use of plasmapheresis can reduce the number of intrauterine infections, low birth weight and oxygen starvation by one and a half times. The procedure reduces the likelihood of bleeding during childbirth, as it normalizes the composition of the blood and reduces the likelihood of blood clots. The most optimal is a combination of plasmapheresis and ozone therapy.

Very good results have been obtained using plasmapheresis for severe forms of gestosis. During a session, it is necessary to process up to 40% of the plasma. Two or more sessions should be carried out with an interval of three to four days.
The procedure is prescribed for recurrent forms of gestosis, with low effectiveness of medications, and with severe edema.

According to data obtained from clinics, the use of plasmapheresis in the treatment of gestosis makes it possible to:

increase the effectiveness of therapy by 1.75 times,
extend the gestation period in case of severe gestosis by 21 days ( average) and for moderate cases for 30 days,
reduce fetal and child mortality during childbirth by 2.5 times,
reduce infection of the fetus and mother during childbirth by 2.9 times,
reduce the period of inpatient observation of women in labor by one and a half times.

There are special types of antibodies that are present in the blood and interfere with conception. These are lupus antigen, antisperm and phospholipid antibodies, antibodies to thyroid cells. Cleansing the blood of these immune complexes helps to conceive and carry a child to term. In many countries around the world, plasmapheresis is prescribed as one of the methods of treating infertility.

For infertility

There is a lot of evidence that plasmapheresis can help maintain pregnancy in women suffering from miscarriage. With this procedure, doctors manage to “hold out” to 34 weeks and get a healthy baby.

More than once doctors have unsuccessfully tried to protect against miscarriage with the help of hormonal drugs. But such therapy is dangerous due to severe disturbances in the formation of the fetus: such children are often born with a disruption of the connection between the pituitary gland, hypothalamus and adrenal glands. Children are born with low birth weight, with underdeveloped kidneys, often with arterial hypertension. Several sessions of plasmapheresis can help women who have already suffered a dozen miscarriages. The procedure reduces the amount of antibodies to the fetus in the mother’s body, regulates blood circulation in the placenta and ensures the birth of a living baby.

A similar procedure is indicated for mothers suffering from lupus erythematosus. Thus, in some women, the lupus anticoagulant completely disappears from the blood, the amount of immunoglobulins decreases by an average of a quarter, and basic blood parameters improve. According to experimental data, with the help of plasmapheresis it is possible to achieve the birth of healthy children in 76% of women suffering from autoimmune diseases. Six percent of women gave birth to babies at 33–34 weeks. At the same time, the children’s body weight was within normal limits, and they were alive.

The procedure is very effective during preparatory activities to IVF. The technique was tested with the participation of sixty volunteers suffering from tubo-peritoneal infertility. The use of plasmapheresis increased the number of successful embryo engraftments by 11%.

13% more people in the plasmapheresis group successfully gave birth to healthy children; these women were three times less likely to suffer from ovarian hyperstimulation syndrome.

In preeclampsia, the use of plasmapheresis prevents hypercoagulation syndrome; in women, the amount of fibrinogen decreased by 16%, regulated prothrombin index, the aggregation rate slowed down ( gluing) platelets by 17%.

For Rhesus conflict

Plasmapheresis for Rhesus conflict is prescribed in order to reduce the amount of antibodies in the mother’s blood to a safe level.

Indications:

the presence and increase in the number of antibodies during gestation,
the presence of antibodies during preparation for conception. Must be prescribed for a history of Rh conflicts.

Contraindications:

the presence of acute viral and respiratory diseases (acute respiratory infections),
the likelihood of premature birth and miscarriage.

In case of Rh conflict, 2–3 procedures are prescribed, during which up to 30% of the plasma is removed and saline solution is introduced instead.
The procedure is prescribed if the number of antibodies increases to more than 1:32. It does not matter at what time the increase in titer was detected. Sometimes for plasma replacement ( especially with a lack of proteins in the blood) instead of saline solution, albumin, thawed plasma, is infused into the blood. If after the first course of treatment the number of antibodies continues to increase, additional courses are prescribed at intervals of 7 days or less. It is important to monitor the level of proteins in the blood.
The effectiveness of the procedure is indicated by a decrease in the amount of antibodies in the blood to 1:16.

In cosmetology

Plasmapheresis is used to treat acne and acne. This is one of important stages cleansing the body of harmful substances that gradually accumulate in the blood and tissues. Plasmapheresis should not be used alone; it is effective only in combination with medications, as well as methods of hardware cosmetology.

Typically, in the course of complex treatment of acne and acne, 3 or more procedures are prescribed. In the first procedure, poisons are removed from the blood. However, large quantities of breakdown products are present in the intercellular fluid, from where they are removed during the second session. The third session helps to cleanse the internal space of the cells. Thus, plasmapheresis allows you to cleanse the body at a very deep level. The rheological properties of blood are improved, the work of all organs and systems is enhanced, metabolism and work are normalized immune system. In addition, the effect of drug treatment is enhanced.

Plasmapheresis is also used for rejuvenation, but only in combination with other treatment methods. With age, tissues are filled with breakdown products of substances, which leads to local inflammatory processes and deterioration of metabolism. Cell supply deteriorates nutrients, they become dehydrated. Plasmapheresis is good because it has a positive effect not only on the skin, but also on the entire body, cleansing it of harmful and unnecessary substances.

For diabetes

In type 1 diabetes, autoimmune reactions are necessarily present. Therefore, plasmapheresis can significantly improve the body’s condition.
With type 2 diabetes, patients very quickly develop atherosclerosis and all the diseases resulting from it. With this type of diabetes, the level of low-density lipoproteins and triglycerides in the blood increases, while the amount of high-density lipoproteins decreases.
Atherosclerosis in such conditions develops at an accelerated pace, which threatens thrombosis and many unpleasant diseases.
For diabetes, the most effective methods are cascade filtration and heparin precipitation.

Indications:

changes in fat metabolism not controlled by medications,
the presence of autoantibodies in patients with type 1 diabetes,
diabetic foot,
diabetic nephropathy,
diabetic retinopathy,
diabetic polyneuropathy.

Contraindications:

allergies to medications used,
disturbance of blood flow,
internal hemorrhage.

Three to twelve sessions are prescribed, during which up to 40% of the plasma is removed from the body. Instead, saline solution or other substitutes are poured in. The procedures are carried out at intervals of two to three days. It is very effective to do a cascade procedure with an interval of 4 to 7 days in the amount of 1 - 3 sessions with processing from 0.5 to 0.8 liters. blood.

The effect of the procedure is to reduce the intensity of manifestations of the disease, improve blood condition, scarring of ulcers with diabetic foot, improving blood circulation in tissues.

Efficiency

Membrane plasmapheresis allows:

increase the activity of hematopoietic, immune, phagocytic cells,
activate blood movement in capillaries,
normalize immunity,
relieve inflammation
eliminate microbes, toxins, and metabolic products from the body.

After the procedures, blood function improves, the patient feels cheerful, and wounds heal faster.

Cleansing the body of poisons
When plasma is removed, viruses, diseased cells, molecules, as well as toxic components that enter the blood, leave the body along with it. Thus, it becomes easier for the liver, kidneys, skin and lungs to work.

Immunity is modulated
Excess immune complexes are eliminated from the blood, due to which chronic inflammatory processes. At the same time, the work of those parts of the immune system that were not working is enhanced.

Improves the rheological properties of blood
A person's blood becomes more viscous with age. This occurs due to changes in some properties of hemoglobin. Sometimes a similar phenomenon is observed in diseases. The function of the myocardium is complicated, since it has to transport more viscous blood through the thinnest network blood vessels. As a result, less oxygen enters the tissues, and microscopic blood clots form on the walls of blood vessels.
Plasmapheresis makes the blood thinner.

Is plasmapheresis dangerous?

Plasmapheresis is a practically safe technique.
1. Only disposable catheters and tubes are used. All kits are sterile and sealed. Right before the start, in front of the patient, they are printed out.
2. Safety is ensured by the constant supervision of the doctor over the patient.
3. The procedure is completely painless. Blood sampling takes place in the same mode as heartbeats. During myocardial contraction, blood is withdrawn from the body, and during expansion it is poured back in. That is, blood circulation is in no way impaired.
4. The procedure does not use medications that may cause side effects or complications. Only saline solution is used to rinse the tubes through which the blood passes. If there are too many hormonal drugs in the patient's body, the excess will be removed by filtration.
Before use, you should consult a specialist.