Plasmapheresis is a type of therapeutic apheresis – a method of extracorporeal (outside the body) blood purification, in which plasma is separated from it, and the rest is returned back to the person.
Types of plasmapheresis
There are centrifugal and membrane plasmapheresis. Centrifugal, in turn, is divided into continuous-flow and intermittent-flow.
In the centrifugal method, blood entering the centrifuge is divided into components under the influence of gravity and the difference in their densities. Red blood cells move to the outer wall of the centrifuge, and plasma closer to the inner wall. Separately, this method allows you to separate platelets and leukocytes located between the layers of plasma and erythrocytes. This leads to the advantage that centrifugal plasmapheresis allows a more selective separation of blood components. Such devices are actively used at transfusion stations for the preparation of plasma and required blood components from donors.
The difference in continuous-flow and intermittent-flow methods lies in the technology and algorithm for supplying the components. Continuous flow – blood from the patient enters the centrifuge and the required component immediately returns back to the body, requires two lines (intake and return), more preferable for therapeutic apheresis; Intermittent flow – only intermediate blood portions are taken, processed and returned to the patient, uses one needle, requires a longer procedure, more anticoagulant, rarely used for therapeutic apheresis.
The membrane method has become more widespread. The principle is somewhat similar to hemodialysis when blood passed through a high-flux filter-separator. The filter contains many membranes with pores of a certain size, which allow only plasma to pass through (a cons comes out of this – you cannot separate other components such as platelets or leukocytes).
What type is better: a centrifugal or membrane
Each method has its pros and cons, here is an approximate list of them:
|High productivity and efficiency in plasma separation||Excretion is limited by the quality and number of pores of the membrane|
|No need for citrate||Less effective with high blood viscosity|
|Inability to separate anything except plasma|
|More blood flow required|
|Heparin is administered, which is contraindicated in complicated bleeding|
|Separation of different blood components||Requires special, heavier equipment|
|No need for heparin||Citrate has a significant number of side effects|
|Possible loss of platelets|
The most appropriate method for the patient should be determined by the physician based on the clinical situation as well as the available equipment in the department.
For the following conditions, the use of plasmapheresis is effective both alone and in combination with therapy:
- Goodpasture’s syndrome (Glomeluronephritis caused by antibodies to the glomerular basement membrane).
- A transplant rejection reaction caused by the patient’s antibodies (including kidney transplantation).
- Blood clotting syndrome
- Guillain-Barré syndrome
- Hemolytic uremic syndrome
- Myasthenic crisis
- Pulmonary renal syndrome with diffuse alveolar damage
- ANCA-associated vasculitis
- Multiple myeloma
- Systemic lupus erythematosus (SLE)
- Schönlein-Henoch purpura and IgA nephropathy (Berger’s disease)
- Poisoning and drug overdose (including death cap poisoning, snake bites, cisplatin overdose).
In addition, since antibodies, circulating immune complexes, various toxic factors, inflammatory mediators are removed during the session, the method has also found application in the following conditions:
- Atopic dermatitis
- Cirrhosis of the liver, refractory itching of the skin (contraindicated with a decreased protein-synthetic function – total protein below 60 g/l).4
- Other diseases with a possible autoimmune nature: rheumatoid arthritis, antiphospholipid syndrome, bronchial asthma, etc.
Contraindications and special instructions
There are the following groups of persons who are not recommended or require supervision during the therapeutic apheresis procedure:
- Problems with vascular access (impossible to install needles, catheter, structural abnormalities).
- Allergy to replacement solution (albumin, fresh frozen plasma).
- Reaction to heparin, active bleeding.
- Citrate anticoagulation is contraindicated in patients with hypocalcemia.
- When using angiotensin-converting enzyme inhibitors (used to lower blood pressure in some patients), it is recommended to stop taking them at least 24 hours before the start of the session.
- Recent myocardial infarction.
Complications of the procedure
Due to the peculiarities of the procedure, based on the stages of the session, some complications or side effects are possible, including:
- Decreased blood pressure (hypotension)
- Discomfort in the stomach, intestines
- Symptoms of hypocalcemia when using citrate anticoagulation (muscle spasms, pain, cramps, brittle nails, dry and peeling skin)
- Numbness and tingling of the extremities
How often can you do plasmapheresis?
On average, at least 3 plasmapheresis procedures are required, but the attending physician determined the specific duration based on the clinical picture of the disease. For example, atopic dermatitis may require 12 procedures, psoriasis 5, transplanted kidney rejection 5-6.
Preparing for the procedure
There are no specific requirements before the session, but you can reduce the risk of some side effects by observing the following points:
- Eat before your session
- Take care of the quality and quantity of sleep the night before
- Drink plenty of water
- It is advisable to be vaccinated according to the vaccination schedule
- Avoid smoking and using tobacco products
- The diet shortly before the scheduled day of the procedure should be dominated by food rich in protein and low in phosphorus, salt, and potassium.
How is plasmapheresis performed?
Upon arrival, the patient takes up a comfortable position, usually lying down. A needle is inserted into each hand, one will be used to draw blood from the patient, and the other to return the already separated from the plasma back. A bottle with a replacement solution – plasma, albumin, or physiological solution – is connected to the same system. If the patient has a catheter installed, then one line of the catheter will act as a supply, and the other as a return.
The general principle, roughly the following – after the start, the pump of the apparatus begins to take blood from the patient, then entering the plasma filter. The filter contains a large number of membranes with pores through which only plasma can pass, and all other components flow further, returning back to the patient. To compensate for the withdrawn plasma and reduce the risks of rapid thickening, a replacement solution and anticoagulants (drugs that prevent clotting) are injected into the system in parallel.
The duration will depend on the required amount of plasma to be withdrawn (usually 500-2000 ml) and averages 60-90 minutes. In case of complaints, it is necessary to inform the medical staff.
At the end of the session, the needle through which the blood entered the system is connected to a physiological solution and the process of returning (reinfusion) of blood back to the patient begins. After its completion, a tight bandage is applied to the injection site, which can be removed after a while.
Plasmapheresis in Kropyvnytskyi
Our department provides plasmapheresis
You can get the plasmapheresis procedure in Kropyvnytskyi in our CNE “City Hospital No. 2 named after St. Anne” KCC. We use certified equipment and consumables in our work. The staff has many years of experience, trained in all aspects of the procedure and its possible complications.
You can find out the current price by contacting us. It may vary based on fluctuations in the cost of consumables.