Plasmapheresis appointment. Plasmapheresis in the treatment of autoimmune diseases. Is plasmapheresis dangerous?

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 for the purpose of treating a number of various diseases. It is about therapeutic plasmapheresis - about its types, indications and contraindications for use, methods of carrying out the procedure, as well as possible adverse reactions and complications 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.

1. 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.
2. Before blood cells are returned to the bloodstream, they are diluted saline solution, glucose and blood substitutes to the required volume. This improves blood flow and reduces the risk of blood clots.
3. 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. Hardware-free methods do not involve the use of 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 all possible indications and contraindications for 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 cardio-vascular system(viral, autoimmune, rheumatic heart disease, systemic vasculitis, atherosclerosis and others);
• pathology of the respiratory system (Wegener's granulomatosis, fibrosing alveolitis, hemosiderosis, and so on);
• illnesses digestive tract (Crohn's disease,
• , hepatic encephalopathy and others);
• diseases endocrine system(, adrenal insufficiency);
• illnesses urinary tract(autoimmune glomerulonephritis, severe pyelonephritis, cystitis and other 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 allergy 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 overdose medicines;
• 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, decreased blood pressure, the appearance of bleeding and so on. In such situations, the doctor must pay increased attention to the patient’s condition and take actions to stabilize it.

Do I need to get examined?

In essence, plasmapheresis is a surgical intervention 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 illnesses);
• blood test for glucose (included in the list of mandatory examinations for every patient, allows you to diagnose diabetes, and in persons with a confirmed diagnosis - monitor blood sugar levels);
• coagulogram (to assess the parameters of the blood coagulation system, detect a tendency to form blood clots or increased bleeding);
• blood test for the Wasserman reaction, or RW (this is also required method diagnostics that allows you to detect or exclude such an unpleasant pathology as syphilis);
• biochemical analysis blood with determination of the level of protein fractions in it (allows you to diagnose hypoproteinemia, which is a relative contraindication to 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 other important parameters of his body. If complications develop, he, of course, provides assistance to the patient.

How many plasmapheresis procedures are needed for a particular patient is determined in 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. After all, plasmapheresis is surgical intervention, which 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:

The plasmapheresis technique is an extracorporeal procedure performed outside the body. Involves the removal of blood for therapeutic purposes and reinfusion cellular elements into the circulatory system. The procedure options are varied. Discrete plasmapheresis is considered accessible and inexpensive and is carried out without the help of specialized equipment. The operation has found application in hematology, pulmonology, rheumatology, surgery, and nephrology.

Discrete plasmapheresis is a method of blood transfusion therapy, including the collection of human blood, purification, and subsequent return of its components purified from plasma back to bloodstream, after adding a blood substitute.

A characteristic feature is that it is done manually and is considered an easy option. The cleaning process is not continuous. The bcc is collected and purified. Options for carrying out the procedure: sedimentation (by settling) and using a centrifuge, where the formation of the level of blood elements and the separation of plasma from them is observed.

Kinds

There is a classification according to purpose of use, method of application and filtration method.

By purpose of use:

• donor - manipulation is carried out with the aim of obtaining donor fluid used for blood transfusions.
• medicinal – to remove toxins. Cleaning occurs by separating the formed elements from the liquid part. The plasma is disposed of or filtered. Once cleaned, pour it back. Preserving only the formed elements, they are returned to the patient’s bloodstream, and the lack of bcc is compensated by plasma substitutes and donor plasma.

By method of use:

1. Discrete - non-hardware plasmapheresis, in which blood collection and transfusion devices are not used.
2. Hardware – the procedure is carried out by a machine, continuously. Connection options: single-needle or double-needle. According to the single-needle scheme, blood is returned and collected from one vein. With a two-needle method, blood is taken from one vein and returned to another.

By filtering method:

1. Sedimentation – separation is carried out by settling.
2. Centrifuge method - a container of blood is centrifuged, leading to the separation of blood into components. It is explained by the difference in centrifugal forces of the constituent parts of the blood.
3. Cascade plasmapheresis removes plasma through plasma filters. The plasma passes through several membranes allowing fractional step-by-step separation of blood.
4. Membrane – allows you to achieve plasma separation with low-porosity plasma filters. The method allows you to keep filtrates sterile, provides protection against infection, there is no pronounced effect on blood cells, and the manipulation takes little time.

There is sedimentation and centrifugal plasmapheresis.

Indications and contraindications for

Indications for manipulation:

• poisoning (endo-, exotoxins);
• cryoglobulinemia;
• disseminated coagulation syndrome;
• autoimmune diseases;
• atherosclerosis;
• sepsis;
• nephrotic syndrome;
• hemolysis;
• porphyria;
• leukocytosis;
• thrombocytosis;
• liver failure.

Plasmapheresis has a number of contraindications.

Absolute contraindications:

1. Disorders of the blood coagulation system (hemophilia, VDD, von Willebrand disease).
2. Presence of bleeding (external, internal).
3. Severe organ injuries.
4. Irreversible changes in the brain and heart muscle.
5. Shock of various etiologies.

Relative contraindications:

• violations heart rate(extrasystole, tachycardia, Hiss bundle block);
• arterial hypotension;
• stomach ulcer;
• anemia;
• acute infectious diseases.

The patient undergoes appropriate preparation, including consultation with a doctor who will help determine contraindications. A blood test is taken to check glucose levels and antibodies to the causative agent of syphilis. A biochemical analysis is carried out to determine the level of proteins. It is important not to miss hypoproteinemia in the patient (proteins are lost during the manipulation process). The coagulation time is assessed to determine the system defect and prevent unexpected blood loss.

The cleaning process occurs as follows:

1. The patient, the donor takes a horizontal position. It is permissible to take a reclining position.
2. Needles and catheter are being installed. You can use one vein, or two if the procedure is carried out using a two-needle scheme.
3. Anticoagulants (heparin) and antihistamines are administered.
4. The collection is carried out into a hemo-container, which is inserted into a centrifuge or settled. The liquid part is separated from the mass of cellular elements.
5. The plasma is taken with a plasma extractor, the red blood cells are washed with saline and returned to the patient’s bloodstream.
6. BCC is replaced by infusion of plasma substitutes and saline.
7. During the procedure, 500-700 ml of plasma is removed. Up to 3 reinfusions are performed at a time.
8. The time spent on the operation ranges from 2.5 to 3 hours.
9. Repeated use is prescribed to consolidate the effect and prevent the recurrence of the pathological condition. It is necessary to repeat the cleaning process from 2-3 to 12 times.

Advantages and disadvantages of the method

Plasmapheresis (manual) has disadvantages:

• open circuit;
• duration of the procedure;
• limited exchange volume (1.5 l);
• imperfect plasma separation;
• cannot be used in hemodynamically unstable patients.

The disadvantage of the method is the possibility of developing complications. The patient is injected with donor plasma and plasma substitute solutions, causing the development of allergies. Manifested by the following symptoms: fever, decreased blood pressure, skin rashes, anaphylactic shock, chills.

A sharp decrease in pressure leads to disruption of microcirculation. It is important to compensate for blood loss.

There is a high probability of missing pathology during the preparation process. Stomach ulcer, which diagnostics did not reveal during preparatory stage, will lead to bleeding.

The manipulation was performed poorly, in violation of asepsis rules, and the introduction of bacteriological microflora is possible.

Violation of the adequacy of the rate of administration of donor plasma provokes the development of citrate intoxication. Normally, sodium citrate is neutralized in the body through slow transfusions. Rapid administration provokes poisoning by the preservative. Sodium citrate captures calcium ions. Intoxication manifests itself as collapse and convulsions.

In the last decade, many modern clinics have begun to offer one expensive procedure - plasmapheresis. What is it and for what diseases is it indicated? Is this technique dangerous and how is it done? Here are the main questions that patients have when it is recommended to them innovative way cleansing the blood of “slags”.

What is plasmapheresis?

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

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

History of the origin of the method

This method dates back to the times when bloodletting was used as a treatment for any disease. On 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 a device for dividing blood into phases and removing its liquid part to obtain a therapeutic effect.

Already in the 70-80s, plasmapheresis began to be actively used in the USA and gained popularity in the USSR. But the evidence of the effectiveness of the method was not yet high enough, because clinical researches require many years of work. However, scientists did not back down and continued to study plasmapheresis. What did this bring to humanity? The perseverance of scientists has given medicine a perfect and effective way to this moment removal of “contaminated” plasma is considered very effective method for many pathological conditions that are accompanied by various intoxications of the body.

What types and methods of plasmapheresis exist?

There are three main classifications of plasmapheresis.

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

80 x 75 x 0.55x0.25 = 825 ml.

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

Can plasmapheresis cause harm?

IN Lately 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 doctors. But just like any other treatment method, it has its own side effects and disadvantages:

• Anaphylactic shock.
• Allergies to donor plasma and replacement fluids.
• Autoimmune kidney damage as a reaction to donor plasma.
• Infection from donor plasma.
• Development of sepsis due to non-compliance with asepsis rules.
• Bleeding (if there are problems with clotting).
• Thrombosis (with insufficient use of anticoagulants).
• Fall in blood pressure.
• Removing not only toxins, but also useful substances along with plasma.
• Short-term decrease in immunity.
• Violation of metabolism and the amount of drugs taken in the blood.
• Nausea.
• Headache.

This is a very serious and complex procedure, so you need to be careful in choosing where to perform the treatment. Many private clinics offer plasmapheresis to patients. What kind of institutions are these, what specialists work there, are there permissions to carry out this procedure? You need to know all this before agreeing to therapy, so as not to fall into the hands of uneducated scammers. After all, this can lead to a disastrous outcome.

What results should you expect?

The effectiveness of plasmapheresis has been proven in the case of many diseases. The positive effect of the procedure is regularly recorded, even with relative indications. However, it is worth understanding that monotherapy may not always help. That's why it's so important to go through complex treatment from 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 the care provided and undergo a preliminary examination to confirm the absence of contraindications to the use of such a treatment technique as plasmapheresis.

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

Let's sum it up

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

Plasmapheresis - innovative methodology, which helps many patients cope with their ailments and cleanse the blood of “contaminated” plasma. This procedure is indicated for a huge number of diseases and has very few contraindications. Carrying out plasmapheresis with the help of qualified specialists and in compliance with all instructions gives positive results in the treatment of even the rarest diseases.

Plasmapheresis is a procedure that is performed by medical indications. During this process, human blood is divided into cells (leukocytes, erythrocytes, platelets) and plasma. Depending on the purpose for which it is used, there are two types of procedures: therapeutic and donor.

Blood purification through plasmapheresis

During the procedure, which is used in medicinal purposes, the blood is separated, removing the plasma. It is the latter that contains allergens, toxins, autoantibodies, etc.

The blood cells are returned back into the bloodstream and the plasma is utilized. Such an event allows you to reduce the concentration in the body of substances that cause harm (toxins, poisons, antibodies, etc.).

Donor plasmapheresis is carried out in a similar way, but for healthy people.

The plasma obtained as a result of blood separation is preserved in order to transfuse it into a sick person in the future or create blood products from it.

Types of procedure depending on the method of blood separation

Exist different types divisions:

1. Sedimentation - plasma is obtained by settling. Blood cells gradually precipitate;
2. Centrifugal - the separation process is accelerated due to the action of centrifugal force;
3. Filtration – special filters are used;
4. Membrane plasmapheresis - special semi-permeable membranes are used that retain cells but allow plasma to pass through;
5. Cascade - the resulting plasma is passed through the filter again. As a result, it is divided into albumin and lipoproteins.

Indications and contraindications for prescribed plasmapheresis

For medicinal purposes, the procedure is performed for many diseases and pathological conditions. For example, it is recommended for exogenous intoxications - food poisoning, drug overdose, after chemotherapy.

It is also carried out in cases of endogenous intoxication - in severe diseases that are accompanied by severe intoxication (eg osteomyelitis, paraneoplastic syndrome, severe infectious processes).

Plasmapheresis is prescribed for autoimmune pathologies For example, it is used to treat bronchial asthma, rheumatoid arthritis, glomerulonephritis, Guillain Barré syndrome, and is used for multiple sclerosis.

It is indicated for blood diseases: multiple myeloma, macroglobulinemia, paraproteinemia, thrombocytopenic purpura, monoclonal gammopathy. The indications also include diseases such as amyloidosis and hypercholesterolemia with atherosclerosis.

Absolute contraindications: bleeding disorders, ongoing bleeding. Relative: acute infectious processes, menstruation, hypoproteinemia, unstable hemodynamics, risk of bleeding (eg, with a stomach or duodenal ulcer).

The benefits and harms of the plasmapheresis procedure

In many commercial medical institutions, patients are misled by prescribing this measure when it is not necessary.

For example, many claim that it has undoubted benefits for women, as it rejuvenates the skin. Similar myths include its ability to cleanse the body of toxins, normalize hormonal levels, metabolism, and immunity.

It is also not true that it can be used for preventive purposes. various pathologies. The procedure is not capable of improving blood microcirculation in tissues and organs; more precisely, there will be an effect, but not from the procedure, but from the heparin that is used during the session.

To cleanse the blood, plasmapheresis will be sufficient: the concentration of certain substances in the biological fluid of the body will decrease. It cannot prevent their formation or get rid of the cause of the disease; moreover, it is used only in combination with other therapeutic measures. Therefore, it is prescribed only when there is an increase in a certain substance in the blood that negatively affects the body, and the risk from the procedure is significantly lower than the harm from the pathology itself.

Complications that may occur:

• pulmonary edema;
• allergies, including anaphylactic shock;
• bleeding disorder, bleeding;
• infection with hepatitis B and C virus, HIV;
• phlebitis;
• hypotension;
• mortality – 1 patient out of 5 thousand.

Plasmapheresis for psoriasis

This method of treating psoriasis is based on replacing its own plasma with blood products, blood substitutes, and electrolyte solutions. As a result, toxins (products of impaired/increased metabolism), bacteria, viruses, and free hemoglobin are removed from the body. During the session, special filters or a centrifuge are used.

With psoriasis, a person’s performance increases, the protective functions of his body are enhanced, and resistance to the effects of negative factors is enhanced. This measure allows you to restore the detoxification organs, therefore slowing down the development of pathology. Blood loss leads to the activation of the body's defenses, the mobilization of iron reserves, tissue proteins and other necessary substances.

Plasmapheresis increases the functional activity of hematopoietic cells, improves microcirculation, has an anti-inflammatory effect, and removes decay products of tissues, cells, microbes and toxic substances.

After the first procedure, psoriasis may worsen sharply, but subsequently there will be regression of the rash. At the second stage of treatment, selective phototherapy, photochemotherapy, ultraviolet irradiation, retinoids and synthetic cytostatics. As a rule, 7 to 10 sessions are performed every other day or two.

Plasmapheresis for autoimmune disease – multiple sclerosis

In this case, this event will cleanse the liver and blood. Harmful substances will be removed from the body. The virus will disappear from the plasma. Toxins and poisons will be removed from the blood. In this case, interferons are not washed out. It is worth noting that after a course of therapy for multiple sclerosis, the condition always worsens, as mentioned above.

The deterioration of the condition is observed over several days, but in some patients the discomfort continues for another 1-2 weeks.

During this period, you need to be especially careful, take care of yourself in every possible way and prevent the occurrence of discomfort. You can take some painkiller, for example, paracetamol, you need to drink pentoxifylline or actovegin.

Then, after a specified time, the condition improves. It is recommended to consume more foods containing proteins before the procedure and throughout the course.

The term "plasmapheresis" comes from the Greek words "plasma" and "apheresis", which can literally be translated as "to separate plasma". In medicine, plasmapheresis is a procedure for estracorporeal blood purification from toxic and ballast compounds. Membrane, or filtration, plasmapheresis differs from other types of this procedure in the way it is carried out: removal toxic substances from the blood is carried out by filtering plasma using special devices with plasma filters.

Principle of plasmapheresis

The principle of blood purification by filtration on a device (Hemofenix, Hemos-PF) is that the blood removed from the vessels is separated using special plasma filters into formed blood elements (erythrocytes, leukocytes, platelets) and plasma. After separation, blood cells return to the patient’s bloodstream, which is why membrane plasmapheresis is called “blood cell washing.” The filtered plasma is collected in a container and disposed of after the procedure; the deficit in circulating blood volume, if necessary, is replenished with plasma-substituting solutions.

Plasmapheresis is auxiliary therapeutic method, which is used therapeutically only in conjunction with the main areas of treatment. The benefits of filtering blood include detoxifying the body, reflex stimulation of the cardiovascular system, increasing immunity, and improving the rheological properties of blood. Feedback from patients about the results of the procedure indicates an improvement in their well-being.

Detoxification of the body

The plasma filter of a device for membrane plasmapheresis is a semi-permeable membrane made of porous fiber with a diameter of 10 microns, between which there are pores with a diameter of 5 microns. Such a filter retains blood cells, but freely passes the liquid fraction of blood along with dissolved in it harmful substances(toxic compounds, antigens of microorganisms, pathological immune complexes).

Stimulation of the cardiovascular system

A decrease in the volume of circulating blood reflexively increases the heart rate, as a result of which the time of one complete circle of blood circulation is reduced. The toxic substances remaining in them are washed out of the tissues faster, which makes it easier to remove them from the body during the next plasmapheresis procedure. If a large volume of plasma is removed during the procedure, its deficiency is restored with the help of plasma-substituting solutions.

Boosting immunity

Passing through the plasma filter, immune cells come into contact with a substance foreign to the human body. As a result of such contact the immune system begins to work hard - a state of “stressed immunity” arises (as after vaccination). Replacing part of the plasma with donor plasma substitutes additionally stimulates the patient's immunity.

Improving blood flow

The improvement in blood flow does not come from the procedure itself, but from the entry of interstitial fluid into the bloodstream after it. Hemodilution occurs - blood thinning due to protein-free solutions.

If necessary, before or during manipulation, patients are administered heparin (70-150 units/kg) of liquid, which helps improve the rheological properties of the blood. In addition, plasma-substituting solutions administered after a session to replenish the deficit in circulating blood volume also dilute it, thereby improving microcirculation in tissues.

Advantages and disadvantages

The membrane plasmapheresis procedure on modern devices has a number of advantages over centrifuge and other types of blood purification:

• one of them is the use of a single-needle scheme, which provides patients with comfort during manipulation;
• Blood purification on the device occurs continuously, so the manipulation time is reduced in comparison with other types;
• if sterile disposable circuits (sets) are used for the procedure, this minimizes the risk of contracting the patient with hematogenous infections;
• the filtration process is carried out under constant computer monitoring, which guarantees its safety.

However, one should not overestimate the capabilities of plasmapheresis: it only reduces the concentration of some harmful compounds in the blood, and does not prevent their formation. Since it does not fight the causes that cause an increase in the concentration of toxic substances, the method does not “work” on its own.

Together with harmful low-molecular compounds (amino acids, electrolytes, acids, alkalis, salts, some enzymes).

In some cases, autoimmune reactions that occur after the procedure are excessive and can provoke an exacerbation of autoimmune processes, therefore, in case of autoimmune pathologies, control immunological studies should be carried out regularly.

The procedure requires strict indications. The expected benefit of plasmapheresis should significantly outweigh the risk possible complications after him.

Indications for the procedure

Indications for therapeutic filtration plasmapheresis, according to the recommendations of the World Hemapheresis Association, are more than 200 different diseases and pathological conditions. These include:

• exogenous and endogenous intoxications of different etiologies ( food poisoning, overdose narcotic substances, alcohol, drugs, condition after chemotherapy and radiation therapy, osteomyelitis, severe infections, paraneoplastic intoxications);
• autoimmune, allergic and dermatological diseases(rheumatoid arthritis, multiple sclerosis, scleroderma, lupus erythematosus, bronchial asthma, hay fever, allergies, dermatomyositis, burn disease, );
• pathologies of pregnancy (Rh-conflicts, gestosis in pregnant women, nephropathy, fetoplacental insufficiency);
• pathologies of the respiratory system (pneumonia, pneumonitis, hemosiderosis, Wegener's granulomatosis, alveolitis);
• diseases of the digestive system (inflammatory and erosive-ulcerative processes, hepatitis, hepatosis, cirrhosis);
• nephrological diseases (pyelonephritis, glomerulonephritis, renal failure);
• pathologies of the central nervous system and sensory organs (neuroinfections, ophthalmopathy, retinopathy, uveitis);
• diseases of the cardiovascular system (ischemia, angina pectoris, cardiomyopathies, myocarditis, post-infarction conditions, hypercholesterolemia, atherosclerosis);
• endocrine pathologies (diabetes mellitus, Addison's disease, hyperthyroidism);
• blood diseases (monoclonal gammopathy, thrombocytopenic purpura, macroglobulinemia, myeloma).

Preventive plasmapheresis once a year is recommended for people working in hazardous industries, as well as before the season colds- persons with reduced immunity.

Contraindications to plasmapheresis

Although membrane plasmapheresis is useful procedure For many diseases, it still has its contraindications. There are:

1. Relative, the elimination of which allows membrane plasmapheresis.
2. Absolute, which make the procedure of blood purification by filtration on membranes impossible.

Relative contraindications to performing filtration blood purification are:

• high risk of bleeding, e.g. peptic ulcer stomach and duodenum;
• acute infections;
• menstrual bleeding;
• low blood protein levels;
• severe anemia;
• edema syndrome;
• states of shock;
• hypotension.

Absolute contraindications include decreased blood clotting, which provokes recurrent bleeding, injury internal organs, mental illness, heart and liver failure, arrhythmias, stroke.

Preparation for the procedure

In preparation for plasmapheresis, the patient undergoes a whole range of laboratory and instrumental studies, which includes: a general and biochemical detailed blood test, coagulogram, testing for hepatitis B and C, HIV infection, syphilis, blood glucose levels, tonometry, electrocardiography. Consultations with a therapist and cardiologist are also required.

A general blood test shows the amount and ratio of formed blood elements and the blood sedimentation rate. The coagulogram determines the clotting time of blood, the tendency to thrombosis or bleeding. A list of biochemical parameters is established depending on the pathology that is the basis for plasmapheresis, and subsequently monitored after each procedure.

Half an hour to an hour before the start of the session, the patient needs to have a snack to avoid fainting. The day before the procedure, it is forbidden to drink alcohol, and immediately before it - to smoke. Also, do not exhaust yourself with heavy physical work or sports activities.

Carrying out blood purification

The patient is connected to a device that, in addition to purifying the blood, monitors pulse, blood pressure, breathing, and oxygen levels in the blood.

In most cases, plasmapheresis is well tolerated by patients. Sometimes they note mild nausea, dizziness, weakness, and drowsiness immediately after the procedure.

After the procedure is completed, the patient needs rest: he needs to lie down in a horizontal position for an hour so that the volume of circulating blood is replenished and its redistribution in the body. During the entire course of treatment, patients should refrain from visiting saunas, hot baths, and exposure to the sun.

Sensitive people with severe side effects(for dizziness, severe weakness), plasmapheresis may be recommended in a hospital setting.

The duration of one procedure can be from 60 to 90 minutes. In one session, up to 25% of blood plasma can be removed from the patient’s bloodstream. The cost of one session depends on the form of ownership of the clinic and ranges from 3 to 8 thousand rubles. At the same time, the city of the event (Moscow, St. Petersburg or Omsk) usually does not affect the price of the manipulation. The number of sessions needed by the patient depends on the disease that served as an indication for plasmapheresis. For example, 3-5 sessions are prescribed for allergic pathologies, 8-10 sessions for severe psoriasis.

Complications after plasmapheresis

After the plasmapheresis procedure, some patients may develop various complications. These include allergic reactions, pulmonary edema, bleeding, phlebitis of the vein to which the system is connected, and a drop in blood pressure. Violation of the rules of asepsis and antisepsis during manipulation can lead to infection of patients viral hepatitis, HIV infection and others infectious diseases with hematogenous transmission.

In one out of five thousand patients who undergo plasmapheresis, complications are so severe that they cause death.

Plasmapheresis is a fairly effective treatment and prophylactic procedure. It can improve the quality of life of long-term ill patients, as well as prevent the development of severe complications they have. However, it is necessary to understand that using it instead of the main treatment of the disease is inappropriate: its effectiveness is reduced significantly.