Plasmapheresis in the treatment of psoriasis: the advantages and disadvantages

Plasmapheresis in psoriasis is an effective way of removing large-molecule toxins from the body, and in addition to other toxic components associated with proteins. This method is one of the types of extracorporal hemocorrection - it is based on replacing the patient's plasma with electrolyte solutions, special blood preparations, and blood substitutes.

Advantages and disadvantages

Among the main advantages of the procedure are:

• noticeable and supported by clinical data reduction of the number of different pathological agents, as well as complexes in the patient's body;
• the procedure stimulates metabolic processes in the patient's body, and also improves immunity;
• in all tissues and organs of the patient microcirculation processes are improving (also over the entire thickness of the skin);
• the blood in large quantities is saturated with oxygen.

The disadvantage is that the hardware membranes prevent not only the effects of pathogenic complexes, but also drugs (for example, hormones).

[1], [2], [3], [4]

Indications for the procedure

The basis for the procedure of plasmapheresis is diagnosed to the patient psoriasis (common or universal) or psoriatic erythroderma, and in addition to some other forms of pathology. The indication can also be high patient resistance to non-steroid drugs.

[5], [6], [7]

Preparation

As preparation for the procedure, the following examinations can be conducted:

• a blood sample for a general analysis - a small amount from a finger or vein. This is a general clinical analysis that allows you to assess the level of blood in the blood of a variety of cells (such as leuko-, erythro- and platelets), as well as hemoglobin, and in addition, the rate at which erythrocyte sedimentation occurs;
• The coagulogram together with the analysis in the period of blood coagulation is taken from the vein. Before the analysis, the patient should not take drugs that affect the coagulation process. This analysis helps to determine the state of the system responsible for blood clotting - to determine whether the patient has a tendency to form blood clots or, conversely, increased bleeding;
• Wasserman's reaction is taken from the vein. This is a standard analysis, which makes it possible to detect the presence of syphilis. It is administered to all adults who enter the treatment;
• analysis on the level of sugar - from the vein, is carried out on an empty stomach. It is performed by patients with diabetes to determine elevated glucose levels;
• analysis on the protein index in the blood - the procedure is performed on an empty stomach, from the vein. Due to the analysis, it is possible to detect the changes in the protein composition that have occurred. This is important, because a low level of proteins in the blood can become a contraindication to the procedure of plasmapheresis;
• measurement of blood pressure - performed using a tonometer. In the case of a low level of blood pressure, the doctor can either postpone or completely cancel the procedure;
• ECG - the patient on the sternum, ankles and wrists fix the electrodes, which transmit to the electrocardiograph the electrical impulses that occur in the heart. During the procedure, the currents forming in the muscles of the heart are recorded under the guise of a curve on paper. According to them, the doctor assesses the state of the heart muscles, atria and ventricles, as well as the rhythm of the heartbeat.

[8], [9], [10]

Technique of the plasmapheresis for psoriasis

In the process of conducting plasmapheresis from the patient's general circulatory system, blood is taken in small portions, which is then passed through a special device.

Blood plasma is purified from various toxic substances, as well as protein molecules, which are the causative agents of allergens and infections, and in addition to these components that are not characteristic of it in a normal physiological state.

The purification process is carried out in various ways - this depends on the specificity of the device used. Sometimes blood is passed through special membranes, and in other cases subjected to disinfecting radiation.

Then, the purified portion of blood is returned to the circulatory system of the patient, taking a new portion in return for a repetition of the purification procedure. Thus, the percentage of harmful elements in the blood gradually decreases.

Contraindications to the procedure

Performing membrane plasmapheresis is strictly prohibited if the patient has serious brain injuries or other organs. In addition, among the contra-indications shock or coma, anemia, the presence of bleeding or problems with blood coagulability. Other contraindications:

• acute stage of phlebitis or abscesses;
• postinfarction, and post-stroke states;
• excessively low pressure index;
• severe nearsightedness or cardiac arrhythmia;
• the patient's elderly age.

There are some contraindications that are not considered strict - in this case the decision to perform / fail to perform the procedure is made by the dermatologist treating the patient (based on the examinations performed). Thus, plasmapheresis can be prohibited if the patient has erosive or ulcerative lesions or tumors.

An additional contraindication for women is the period of menstruation. In addition, the procedure can be inhibited with a low level of protein in the blood serum.

Complications after the procedure

The procedure is also capable of causing some complications:

• an allergy that develops as a response to the introduction of plasma substitutes and donor plasma, and in addition to preservatives and anti-clotting agents, they are contained in frozen plasma. Symptoms are chills, rashes on the skin and fever;
• anaphylaxis is a severe form of an allergic reaction, in which there is a sharp decrease in blood pressure, a violation of consciousness and a disorder of the heart function;
• intoxication with citrate is a substance used to reduce blood clotting, as well as preventing the formation of thrombi during the procedure. In this case, the patient experiences numbness in certain parts of the body, as well as muscle cramps;
• decrease in blood pressure, which occurs in the case if the patient takes too much blood for purification;
• a disorder in the work of the kidneys - occurs due to autoimmune reactions in the process of plasmapheresis or because of incompatibility with the donor's blood plasma recipient;
• penetration into the blood of infection, resulting in the development of infection (sepsis). This mainly occurs as a result of violation of the rules concerning asepsis;
• HIV infection. Since these days one-time instruments are used for the procedure, the risk of penetration of the virus into the patient's blood is almost zero;
• bleeding - due to an overdose by means that are used to reduce blood coagulability, it is possible to form subcutaneous hemorrhages (or internal organs). In particular, this risk is high in patients who have intestinal or gastric ulcers;
• thromboses, which are formed due to the use of insufficient amounts of funds that reduce blood clotting - they appear in the catheter or on the vascular wall next to it. A piece of this thrombus can come off and enter the bloodstream - this disorder is called thromboembolism. The most dangerous development of thromboembolism in the pulmonary artery, as the thrombus penetrates into the vessel, which carries the blood into the lungs, clogging the lumen, which is fraught with the development of severe consequences.

[11], [12]

Reviews

Plasmapheresis in psoriasis alone is not capable of producing an effective result, but in the case of the connection with other traditional methods, this greatly improves the condition - this fact is confirmed by both patients and physicians. For example, a plasmapheresis compound with hemosorption is effective for many (it is a technique that allows removing toxic elements from the blood, as well as regulating homeostasis).

The patients' comments regarding the duration of the remission period are quite different. In some cases, the disease disappears for a certain time (for example, for 6 months), and then reappears, and in an even heavier form. Some specially undergo a procedure at the end of autumn, so that the disease does not start in winter. There are also people who did not notice any changes at all, while others are very happy, because the procedure was very effective.

To get rid of the problem for a long period, it is usually possible for those patients who, in addition to passing plasmapheresis, also observe a special diet, and in addition recommendations of dermatologists - take prescribed medications and swim in saline ponds.