Therapeutic haemapheresis

Therapeutic hemapheresis includes plasmapheresis and cytarapheresis, which are usually tolerant for healthy donors. However, there are many small and somewhat significant risks. The installation of venous catheters necessary for hemapheresis can cause complications (bleeding, infection, pneumothorax). Citrate anticoagulant can reduce the content of serum ionized calcium. Replacing the blood plasma with non-colloidal solutions (for example, physiological sodium chloride solution) leads to the movement of fluid into the extravascular space. Colloidal solutions do not replace IgG and clotting factors.

Most complications can be monitored with close monitoring of the patient's condition and regulation of the procedure parameters, but some severe reactions and individual deaths are recorded.

Plasmapheresis

Therapeutic plasmapheresis removes plasma components from the blood. The blood cell separator removes the plasma of the patient and returns erythrocytes and platelets or plasma-substituting solutions; To this end, 5% albumin is more preferable than fresh-frozen plasma (except for patients with thrombotic thrombocytopenic purpura), because albumin causes fewer transfusion reactions and is not a carrier of infections. The therapeutic plasmapheresis has a similarity to dialysis, but is additionally capable of removing protein-related toxic substances. The exchange of one volume of plasma removes about 66% of such components.

To achieve the effect, plasmapheresis must be used in diseases where the plasma contains known pathogenic substances and plasmapheresis can remove these substances faster than the body produces them. For example, with rapidly progressive autoimmune diseases, plasmapheresis can be used to remove harmful plasma components (eg, cryoglobulins, anti-glomerular antibodies), while immunosuppressive or cytotoxic drugs disrupt their production. There are numerous indications for plasmapheresis. The frequency of plasmapheresis, the volume of the removed plasma, the type of replacement solution and other parameters are individual. Low-density lipoprotein cholesterol can be removed by plasmapheresis using the recently proposed instrumental filtration technique. Complications of plasmapheresis are similar to complications of therapeutic cytapheresis.

Indications for plasmapheresis in accordance with the recommendations of the American Society of apheresis and transfusion medicine s 

Category	Plasmapheresis	Cytapheresis
I. Standard interventions recommended in certain circumstances, including primary therapy	Acute inflammatory demyelinating polyradiculoneuropathy. Disease caused by anti-glomerular antibodies. Chronic inflammatory demyelinating polyradiculoneuropathy. Demyelinating polyneuropathy with IgG / IgA. Myasthenia gravis. Disease accumulation of phytic acid. Posttransfusion purpura. Thrombotic thrombocytopenic purpura	Cutaneous T-cell lymphoma: photopheresis. Erythrocytosis / true polycythemia. Family Hypercholesterolemia: Lipid Absorption Hyperleukocytosis: leukemia. Sickle-cell anemia: erythrocyte exchange. Thrombocytosis: platelet depletion
II. Recommendations that have sufficient evidence of effectiveness; Possible as an additional treatment	ABO incompatible bone marrow transplantation (recipient). Acute inflammatory demyelinating disease of the central nervous system. Inhibitors of coagulation factors. Cryoglobulinemia. Cryoglobulinemia with polyneuropathy. Family hypercholesterolemia. Eaton-Lambert syndrome. Myeloma / acute renal failure. Myeloma / paraproteins / hyperviscosity / PANDAS (pediatric autoimmune neuropsychiatric diseases associated with streptococcal infections). Polyneuropathy with IgM (+ Waldenstrom). Rapidly progressive glomerulonephritis. Chorea	Chronic "graft versus host disease": photopheresis. Erythrocytosis / true polycythemia: depletion of erythrocytes. Hyperparasitemia is malaria. Babesiosis: erythrocyte exchange. Idiopathic thrombocytopenic purpura: immunoadsorption. RA: immunoadsorption

Cytapheresis

The therapeutic cataracts remove the cellular components from the blood, returning the plasma. It is most often used to remove defective erythrocytes and replace them with normal ones in patients with sickle-cell anemia with the following conditions: acute coronary syndrome, stroke, pregnancy, frequent crises. With the help of cytapheresis, the level of HbS <30% is achieved without the risk of increasing the viscosity of the blood, which can occur with normal transfusion. Therapeutic cytarapheresis can be used to reduce expressed thrombocytosis or leukocytosis (cytoreduction) in acute or chronic leukemia when there is a risk of bleeding, thrombosis, pulmonary or cerebral complications caused by high leukocytosis (leukostasis). Cytapheresis is especially effective in thrombocytosis, because platelets are not replaced as quickly as leukocytes. One or two procedures reduce the level of platelets to a safe level. A therapeutic decrease in the number of leukocytes (leukapheresis) can remove kilograms of leukoconcentrate for a small number of procedures, which often reduces leukostasis and splenomegaly. However, the decrease in the number of leukocytes occurs only to a small extent and for a short time.

Another indication for the use of cytapheresis is the fence of peripheral blood stem cells for autologous or allogeneic transplantation, and the collected lymphocytes are used for immunomodulation in cancer therapy.

[1], [2], [3]