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Discrete plasmapheresis is a method of gravitational blood purification, which removes pathological substances and excess physiological compounds from plasma. These substances can be of both exogenous (bacterial and plant toxins and poisons, alcohol and its surrogates, drugs) and endogenous origin (circulating immune complexes, hormones, nitrogenous substances).
This type of plasmapheresis allows you to renew the cell pool in the blood, improve the rheological properties of blood and microcirculation, activate normal immune responses, eliminate inflammation, get rid of pathogens of infectious diseases, their toxins and toxic metabolic products. Against the background of these changes in the body, patients note a significant improvement in well-being, a surge of energy and cheerfulness.
Pathological compounds and excessive amounts of physiological substances and their complexes are pathogenetic factors that support the course of the disease and contribute to the development of complications.
Their removal from the body reduces the clinical picture of the disease, reduces the burden on the liver and kidneys, and improves the patient’s well-being.
Advantages and disadvantages
The advantages of the discrete plasmapheresis method are its availability, ease of implementation, safety and no need for expensive equipment.
In comparison with other methods of extracorporeal hemocorrection (hemosorption, hemodialysis, hemofiltration, plasmasorption), discrete plasmapheresis injures blood cells less.
The main disadvantage of this type of plasma purification is its non-physiological nature. It provides for the purification of blood after its removal from the bloodstream. By this, it is inferior in its physiology to membrane plasmapheresis.
Indications for conduction
Discrete (centrifuge) plasmapheresis is used to detoxify the patient’s body. It is used to reduce the concentration of autoimmune complexes in the blood, pathological antigens and antibodies, toxic metabolic products, hormones, inflammatory mediators, to reduce poisons and toxins. Thus, with the help of discrete plasmapheresis, homeostasis is normalized and immunity is corrected.
There are many indications for discrete plasmapheresis. Among them are rheumatological diseases:
- nodular periarteritis;
- gout;
- rheumatoid arthritis;
- systemic lupus erythematosus;
- dermatomyositis;
- scleroderma;
- thromboangiitis obliterans;
- systemic vasculitis.
Plasmapheresis in these diseases cleanses the blood of circulating immune complexes, rheumatoid factor, seromucoid, inflammatory mediators, autoantibodies, fibrinogen.
Allergies and allergic diseases (bronchial asthma, angioedema, acute urticaria, hay fever) will also be an indication for plasmapheresis. The procedure removes immunoglobulins E and antigens from the plasma that cause hyperreaction.
It is worth considering going for manipulation when the patient is concerned about dermatological diseases (psoriasis, neurodermatitis, eczema, atopic dermatitis, furunculosis), neurological pathologies (multiple sclerosis, polyneuropathy, chronic fatigue syndrome, myasthenia gravis), as well as intoxication and poisoning (alcohol, narcotic substances , poisons).
Plasmapheresis is indispensable for diseases of the liver, diseases of the cardiovascular system, blood, and pathologies of the urinary and male reproductive systems.
Discrete plasmapheresis is used in obstetrics and gynecology for certain diseases and pathological conditions (ureaplasmosis, cytomegalovirus infection, Rhesus conflict, gestosis and nephropathies in pregnant women, miscarriage, infertility, menopause, inflammation of the appendages).
Contraindications for manipulation
The procedure is contraindicated in terminal conditions, infectious-purulent complications and septic conditions, blood clotting disorders, allergies to fluids to restore circulating blood volume (plasma, proteins), bleeding, gastric and duodenal ulcers in the acute phase, malignant neoplasms.
Relative contraindications to plasmapheresis are low blood pressure (below 90 mm Hg), tachycardia, hypohemoglobinemia (below 90 g/l), hypoproteinemia (below 55 g/l). After correction of these hemodynamic disorders, the procedure is considered possible. The procedure is prohibited during cyclic menstrual bleeding in women.
Preparation for plasmapheresis
To confirm the validity of the appointment of discrete plasmapheresis, a preliminary consultation with a transfusiologist is required. To exclude possible contraindications to the procedure, the patient is examined in the laboratory. The list of necessary tests includes a general and biochemical blood test, a coagulogram, a blood group and Rh factor, and a general urine test. Depending on the pathology, this list may be supplemented by other laboratory or instrumental studies.
Procedure
Blood is taken from peripheral veins. After venipuncture, heparin and antihistamines are injected into it, after which blood is exfused (taken). Blood from the bloodstream is collected in a disposable polymer sterile container with a volume of 300-500 ml with a preservative (Gemacon, Compoplast). The blood container is sent to a refrigerated centrifuge where the blood is separated into cell mass and plasma.
The separated plasma is sucked out of the container using a plasma extractor. The remaining cell mass is washed with saline and returned back to the bloodstream using a dropper (reinfusion). To avoid hypovolemic shock, the patient’s circulating blood volume deficit is restored with the help of donor plasma, plasma-substituting, colloidal, crystalloid solutions, and albumins.
Exfusion and reinfusion in one session of discrete plasmapheresis is repeated three times. The duration of the entire procedure is 2,5-3 hours. During this time, about 600-800 ml of plasma is removed from the bloodstream (but not more than 25% of the volume of circulating blood).
After the session, the pathological compounds and complexes contained in it actively enter the blood from the intercellular fluid. To cleanse the entire body of toxic substances, the patient needs to undergo a course of plasmapheresis. The number of procedures for one treatment course is set by the doctor, based on the diagnosis of the patient. The therapeutic course of discrete plasmapheresis may include from 2-3 to 10-12 procedures.
Adverse Reactions
The procedure is painless and is usually well tolerated by patients. Sometimes after it, patients feel nausea or slight dizziness. To prevent fainting, the patient after the end of the manipulation remains in the clinic for some time. In 1-2 hours, the volume of circulating blood in him is restored due to the entry of intercellular fluid into it, and the patient’s well-being improves.
Possible complications
Despite the relative safety of the procedure, it is still associated with blood, so various complications can occur during and after it. If they appear during the procedure, plasmapheresis must be stopped, and the patient should be given the necessary assistance.
During the procedure, allergic reactions to fluids to restore the volume of circulating blood (donor plasma, albumins, colloidal solutions) may develop. Allergic reactions are manifested in the form of fever, vegetative disorders (chills, tachycardia, lowering blood pressure), rash and itching. When they occur, patients are administered antihistamines, sedatives, corticosteroids.
Against the background of the introduction of anticoagulants in persons with impaired blood clotting, bleeding may open. Most often, bleeding occurs from ulcerative defects on the mucous membrane of the gastrointestinal tract, from the rectum with pathologies of hemorrhoidal veins, and from the uterus in women. With the development of hemorrhagic syndrome, the patient is administered protamine sulfate to neutralize heparin and hemostatic drugs.
In case of violation of the rules of the procedure and the use of reusable medical supplies, bacteremia or septic complications are possible. When transfusing donor plasma, there is a possibility of contracting viral infections (hepatitis B, C, HIV).
The cost of one procedure of discrete plasmapheresis in Russian clinics ranges from 2 to 10-11 thousand rubles, depending on the region and the form of ownership of the clinic. On average, the price of one session in Moscow is 3500 rubles.