Therapeutic Plasma Exchange - Possibilities and Perspectives at the Turn of the Millenium

Overview

The authors describe briefly the historical origin of therapeutic plasma exchange, its principles, terminology and physical basis. Subsequently he presents a classification of diseases indicated for treatment by plasmapheresis into four categories. The different categories describe disease where treatment is unequivocally indicated, indicated as supplementary and auxiliary treatment, indicated according to the literature with an uncertain effect, or suitable only as part of research protocols. The author describes possibilities of using therapeutic plasma exchange from the aspect of pathogenesis of different diseases. He mentions possibilities as regards intensity and frequently of treatment along with possible selection of a substitute solution. Attention is paid also to different ways of connecting the patient to extracorporeal circulation, possibilities of ensuring non-coagulating blood in the extracorporeal circulation and the most frequently encountered complications. The author describes also methods and techniques of selective extracorporeal immunomodulation on the principle of immunoadsorption and the possible application of these methods in clinical practice, as compared with plasmapheresis. In The conclusion the author evaluates the importance of therapeutic plasma exchange and immunoadsorption and extension of these therapeutic apheretic methods on a worldwide scale.

Key words:
plasmapheresis - therapeutic plasma exchange - immunoadsorption