Plasmapheresis in the treatment of psoriasis: advantages and disadvantages

Plasmapheresis for psoriasis is an effective way to remove large-molecular toxins from the body, as well as other toxic components associated with proteins. This method is one of the types of extracorporeal hemocorrection - it is based on the replacement of the patient's plasma with electrolyte solutions, special blood products, and blood substitutes.

Advantages and disadvantages

Among the main advantages of the procedure:

• a noticeable and clinically confirmed reduction in the number of various 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 improve (also throughout the entire thickness of the skin);
• the blood is saturated with oxygen in large quantities.

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

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Indications for the procedure

The basis for the plasmapheresis procedure is the patient's diagnosed with psoriasis (common or universal) or psoriatic erythroderma, as well as other individual forms of pathology. The indication may also be the patient's high resistance to non-steroidal drugs.

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Preparation

In preparation for the procedure, the following examinations may be performed:

• blood sampling 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 various cells in the blood (such as leukocytes, erythrocytes and thrombocytes), as well as hemoglobin, and in addition, an indicator of the rate at which erythrocytes settle;
• coagulogram together with the analysis during the blood clotting period - taken from a vein. Before the analysis, the patient should not take medications that affect the clotting process. This analysis helps to determine the state of the system responsible for blood clotting - to identify whether the patient has a tendency to form blood clots or, conversely, increased bleeding;
• Wasserman reaction - taken from a vein. This is a standard test that allows you to detect the presence of syphilis. It is performed on all adults who are admitted for treatment;
• sugar level test - from a vein, performed on an empty stomach. It is performed on patients suffering from diabetes to determine elevated glucose levels;
• Blood protein analysis - the procedure is performed on an empty stomach, from a vein. The analysis can identify changes in the protein composition. This is important because a low level of proteins in the blood can be a contraindication to the plasmapheresis procedure;
• Measuring blood pressure indicators - is carried out using a tonometer. In case of low blood pressure, the doctor can either postpone or cancel the procedure;
• ECG – electrodes are attached to the patient’s sternum, ankles and wrists, which transmit electrical impulses occurring in the heart to the electrocardiograph. During the procedure, the currents forming in the heart muscles are recorded on paper as a curve. Based on them, the doctor evaluates the condition of the heart muscles, atria and ventricles, as well as the heartbeat rhythm.

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Technique plasmapheresis for psoriasis.

During plasmapheresis, small portions of blood are taken from the patient's general circulatory system and then passed through a special device.

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

The purification process is carried out in different ways, depending on the specifics of the device used. Sometimes the blood is passed through special membranes, and in other cases it is exposed to disinfectant radiation.

The purified portion of blood is then returned to the patient's circulatory system, taking in exchange a new portion to repeat the purification procedure. In this way, the percentage of harmful elements in the blood is gradually reduced.

Contraindications to the procedure

It is strictly forbidden to perform membrane plasmapheresis if the patient has serious brain or other organ injuries. In addition, contraindications include shock or coma, anemia, bleeding or blood clotting problems. Other contraindications:

• acute stage of phlebitis or abscesses;
• post-infarction and post-stroke conditions;
• excessively low blood pressure;
• severe myopia or cardiac arrhythmia;
• advanced age of the patient.

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

An additional contraindication for women is the menstrual period. In addition, the procedure may be prohibited if the protein level in the blood serum is low.

Complications after the procedure

The procedure can also cause some complications:

• an allergy that develops as a response of the body to the introduction of plasma substitutes and donor plasma, as well as preservatives and anticoagulants - they are contained in frozen plasma. Symptoms include chills, skin rashes and fever;
• anaphylaxis is a severe form of allergic reaction, in which there is a sharp decrease in blood pressure, impaired consciousness and impaired cardiac function;
• Citrate intoxication is a substance used to reduce blood clotting and prevent blood clots from forming during the procedure. In this case, the patient experiences numbness in certain parts of the body, as well as muscle cramps;
• a decrease in blood pressure, which occurs if too much blood is taken from the patient for purification;
• kidney dysfunction – occurs as a result of autoimmune reactions during plasmapheresis or due to incompatibility with the donor’s blood plasma;
• penetration of infection into the blood, resulting in infection (sepsis). This usually occurs as a result of violation of the rules concerning asepsis;
• HIV infection. Since disposable instruments are used for the procedure these days, the risk of the virus entering the patient's blood is practically zero;
• bleeding - due to an overdose of drugs used to reduce blood clotting, subcutaneous hemorrhages (or in internal organs) may occur. This risk is especially high in patients who have intestinal or gastric ulcers;
• thromboses that form as a result of using insufficient amounts of blood clotting agents - they appear in the catheter or on the vascular wall next to it. A piece of such a thrombus can break off and enter the bloodstream - this disorder is called thromboembolism. The most dangerous development of thromboembolism is in the pulmonary artery, since the thrombus penetrates the vessel that carries blood into the lungs, blocking the lumen, which is fraught with the development of serious consequences.

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Reviews

Plasmapheresis for psoriasis alone is not capable of bringing an effective result, but in the case of combination with other traditional methods, it significantly improves the condition - this fact is confirmed by both patients and doctors. For example, a combination of plasmapheresis with hemosorption is effective for many (this is a technique that allows you to remove toxic elements from the blood, as well as regulate homeostasis).

Patients' reviews regarding the duration of the remission period are quite different. For some, the disease disappears for a certain period of time (for example, for 6 months), and then reappears, and in an even more severe form. Some specifically undergo the 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, on the contrary, are very happy, as the procedure was very effective.

Patients who, in addition to undergoing plasmapheresis, also follow a special diet and, in addition to the recommendations of dermatologists, take prescribed medications and swim in salt water usually manage to get rid of the problem for a long period.