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Therapeutic Hemapheresis by Daniel Williams
Therapeutic hemapheresis is a procedure that removes blood through an intravenous line from a patient into a container under sterile conditions. It is then spun down or centrifuged to separate the components of the blood. The component that contains a harmful substance is removed and the remaining components are then returned to the patient through another intravenous line.
Sometimes once the harmful substance is remov
ed, there is a rebound phenomenon in which the same substance enters the blood after overproduction has been stimulated. Also, although laboratory tests may suggest an improvement, clinical assessment may reveal no significant changes have resulted from the procedure.
There are four basic types of these procedures. Plamapheresis is the removal of the yellowish tan fluid of blood that contains several proteins. There are three types of cytapheresis or removal of cells. Erthrocytaphesis is the removal of red cells that carry oxygen. Plateletpheresis is the removal of platelets that assist in clotting. Leukapheresis removes white blood cells that are involved in fighting infections.
Complications are usually minor such as numbness or tingling which may be due to the anticoagulant citrate, which lowers the calcium level. The patient may experience chills, dizziness and fatigue. Rarely a cardiac arrhythmia may occur. The death rate is about 3 per 10,000 procedures, however, many patients who undergo therapeutic hemapheresis are severely ill prior to the treatment.
Replacement fluids include saline, 5% albumin and fresh frozen plasma. The latter, which contains some coagulation factors, has a small risk for infective agents and transfusion reactions.
Plasmapheresis may be indicated for the following:
1) Guillain-Barre Syndrome that is commonly preceded by an infection, vaccination, surgery or trauma is an inflammatory peripheral nerve demyelination or destruction of the sheath surrounding nerves. If the progressive motor weakness prevents walking without assistance and artificial ventilation is required, plasmapheresis should be considered especially within the first two weeks of the onset of symptoms. Intravenous immunoglobulin (IgG) may be beneficial.
2) Goodpasture's syndrome leads to rapidly progressive renal failure due to anti-basement antibodies in the glomeruli of kidneys.
3) Conditions associated with increased viscosity of serum can lead to renal, visual and neurological impairment along with bleeding tendency. a) Waldentrom's Macroglobulinemia is due to IgM. b) Multiple Myeloma due to a plasma cell dyscrasia that infiltrates the bone marrow. The criterion to perform plasmapheresis is determined by the symptoms and changes of the eyes. c) Cryoglobulinemia occurs when abnormal proteins in the blood agglutinate upon exposure to cold.
4) Myasthenia Gravis is an autoimmune disease in which autoantibodies are directed to the neuromuscular junction and produces fatigue of voluntary muscles. Cholinesterase inhibitors, steroids and azathioprine are used. However, plasmapheresis should be considered in a patient unresponsive to drugs or in an acute crisis.
5) Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura may be manifestations of the same disease with thrombi or clots in small blood vessels. This is associated with fever, hemolytic anemia (fragmented red cells) and low platelet counts as well as neurological and renal impairment.
6) Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) may be the chronic form of Guillain-Barre Disease. Patients who have life-threatening symptoms and are unresponsive to steroids or intravenous immunoglobulins may benefit from plasmapheresis.
7) HELLP or hemolysis, elevated liver enzymes and low platelet count syndrome is a severe type of preeclampsia of pregnancy. If delivery cannot be done or if the low platelet count persists in the postnatal period, plasmapheresis should be considered.
8) Post-transfusion Purpura, a rare condition, occurs within a week following a transfusion in which the patient develops bleeding secondary to a low platelet count attributable to a platelet antibody.
9) Pemphigus Vulgaris is an autoimmune skin disease with blisters, which is treated with steroids and other immunosuppressive drugs. Plasmapheresis should be considered as adjunctive therapy. Although a rebound phenomenon can be anticipated to follow after the removal of the autoantibodies, cyclophosphamide, an immunosuppressive drug, is more effective in destroying the newly proliferating autoantibodies.
10) Homozygous Familial Hypercholesterolemia has plasma lipid components such as low-density lipoprotein (LDL) which contribute to atherosclerotic cardiovascular disease. Affected patients have their blood filtered through a special membrane that selectively removes LDL.
Erythocytapheresis:
Sickle cell anemia patients who are pregnant, pre-operative or in crisis may benefit from the removal of defective red blood cells and the transfusion of donor red blood cells.
Plateletpheresis:
Symptomatic thrombocytosis is when the platelet count is so high that there are thrombi in small vessels, which have begun to cause clinical impairment.
Leukapheresis:
1) Acute and Chronic Leukemia with large numbers of white blood cells in the blood may create thrombi in small blood vessels in the lungs, heart, brain, kidneys or spleen.
2) Cutaneous T cell lymphoma is a skin lymphoma in which patients have circulating malignant cells in their blood. After leukapheresis the benign white cells and malignant cells are treated with photosensitizing medication that makes the malignant cells easily destroyed by ultraviolet irradiation. When this is returned to the patient, the destroyed cells are removed by the patient's own immune system which is stimulated to produce antibodies to the malignant cells in the skin. A similar technology such as this may be used to reduce the risk of organ transplant rejection.
Plamapheresis, erythrocytapheresis, plateletpheresis and leukapheresis continue to serve as an acceptable form of treatment for certain diseases and a supportive or adjunctive therapy for others. Many of these treatments are used when standard ones are not producing the desired results and the clinical situation has deteriorated. These procedures are also being investigated to determine what if any impact they may have on the clinical course of several other diseases.
About the Author Author: Daniel Williams has been an online entrepreneur since 1998. He is webmaster of SarasotaFreeAds.com and lives in Sarasota, Florida 34237. You are permitted to reprint this article provided it is done so in its entirety including this signature box and remains unchanged except for formatting.
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