Semiselective immunoadsorption of anti-AChR abs on tryptophan column in myasthenia gravis. Clinical experience in 32 patients

Therapeutic Plasma Adsorption. A Review

Alternative techniques to the traditional plasma exchange are emerging in clinical practice for the treatment of different pathological conditions, particularly autoimmune diseases. Filtration is a technique used to separate blood cells from plasma, which may be further “treated” with other filters or columns. The case for cascade filtration and absorption onto a column is becoming stronger and stronger and the patient population is increasing. Alongside the “historical” techniques of adsorption onto a column, new systems (pairs of self-regenerating columns) and new products (columns with dextran sulphate, tryptophane, anti-human lipoprotein antibodies) are now available. Protein A in particular seems to open up new horizons; in therapeutic plasmapheresis, there are two versions, one Swedish and the other American, based on different theoretical premises and obtaining different results, with different biocompatibilities but good clinical results.

Plasma Exchange: The Cost/benefit Ratio and the Critical Revision of Indications

The number of conditions that can benefit from Plasma-Exchange (PE) continues to grow. We have recently added to the list the Cyclosporin-A induced hypertrygliceridemia and myoglobinuric acute renal insufficiency.

Such as any therapeutic measure for PE, four evolutive phases can be recognized: the discovery and research, the confirmation of indications, the routine applications and the decline, when new more powerful tools are offered by culture or technology. We have participated in the first three phases during the last 20 years.

Not necessarily all experiences were favourable. Nonetheless, we feel that, for the time being, a hemapheresis unit is an absolute necessity for a medium - sized hospital even if only therapeutic procedures are carried out. The phase four, decline of interest and applications, cannot be foreseen. Finally the ability of PE to shorten substantially the length of hospital stays along with the ease with which procedure can be performed on ambulatory patients, substantiate a favourable cost/benefit ratio for this therapeutic modality.

Clinical Applications of Therapeutic Hemapheresis

Therapeutic hemapheresis may be a life-saving treatment for patients with some diseases, such as thrombotic thrombocytopenic purpura (TTF), Goodpasture's syndrome, and leukemia-induced leukocytosis, among others. Although plasma exchange has been applied for treatment of many conditions, during the last decade a consensus has been reached about the specific but limited number of diseases for which it is of definitive benefit. Some patients are severely ill during the course of the disease, and they require prompt treatment in the intensive care unit. Therapy of these patients is discussed in this review in detail, in addition to technical aspects, indications, contraindications, and complications of therapeutic hemapheresis.