Most complications of apheresis may be dominated by a close monitoring of the patient and slight changes in the process. However, it is occasionally severe reactions and even some deaths have been reported.
The therapeutic apheresis includes the plasma exchange and cytapheresis that are well tolerated by healthy donors in general. Yet there is this many smaller and some larger risks that must be observed. For apheresis investing at large is i.v. necessary additions, can be caused by the complications (eg., bleeding, infection, pneumothorax). Citrate as an anticoagulant is used, which leads to a reduction of the ionized calcium in the blood. The replacement of plasma by a non-colloidal liquid (eg., Saline) will result in a fluid shift in the extravascular space. However, colloidal alternative solutions do not replace immunoglobulins and clotting factors. Most complications of apheresis may be dominated by a close monitoring of the patient and slight changes in the process. However, it is occasionally severe reactions and even some deaths have been reported. Plasma exchange The therapeutic plasma exchange plasma components are removed from the blood. Using a blood cell separator to the patient’s plasma is removed and returned erythrocytes and platelets with plasma or an appropriate replacement fluid. Here, 5% albumin with respect to fresh frozen plasma preferred (except in patients with thrombotic thrombocytopenic purpura-) because it causes fewer reactions and thus no infections can be transmitted. The therapeutic plasma exchange resembles dialysis but on the exchange protein-bound toxic substances can be removed in addition. A simple volume exchange about 66% of these components are removed. A clinical benefit, the plasma exchange with such diseases in which the plasma contains a known pathogen, which can be removed quickly by means of plasmapheresis, as it is reproduced through the body. For example, they can be used in fast progressive autoimmune diseases to harmful plasma components such. remove as Cryoglobulins or antiglomerular Basalmembranantikörper. A parallel administered immunosuppressive therapy suppresses their future formation. There are numerous indications for plasma exchange (see table: indications for plasma exchange, according to the American Society for Apheresis). (See also Guidelines on the Use of Therapeutic Plasma Exchange.) The frequency of plasma exchange, the removed volume, the replacement fluid and other variables must be individualized for each patient. Low-density lipoprotein cholesterol can (called LDL apheresis) by adsorption on a column are selectively removed from the plasma. When the photopheresis mononuclear cells are selectively removed by centrifugation and with photoactivatable drug treated (e.g., 8-methoxypsoralen.) Which are then activated with UV light; this is a form of chemotherapy. In the immunoadsorption is an antibody or antigen from plasma by the combination with an antigen or antibody, the / is selected to bind the desired antibody or desired antigen through a column removed. The complications of plasma exchange are similar to the therapeutic cytapheresis. Indications for plasma exchange, according to the American Society for Apheresis Category plasma exchange cytapheresis ANCA-mediated I. Accepted as a primary therapy, either alone or together with other treatment methods, fast progressive glomerulonephritis (granulomatosis with polyangiitis [formerly Wegener’s granulomatosis]), patients receiving dialysis or in diffuse alveolar hemorrhage Goodpasture’s syndrome ( “antiglomerular basement membrane antibody disease”) patients receiving dialysis or in diffuse alveolar hemorrhage Chronic inflammatory demyelinating polyneuropathy cryoglobulinemia difficult Focal segmental sklerosier glomerulonephritis, recurrent Guillain-Barre syndrome hemolytic uremic syndrome, atypical by autoantibodies against factor H hyperviscosity with monoclonal gammopathy liver transplantation for desensitization, living donors (in the presence of ABO incompatibility myasthenia gravis PANDAS immunologically related neurological-psychiatric diseases in childhood associated with a streptococcal infection) -Exazerbation. Paraproteinämische polyneuropathy with IgG / IgA, IgM kidney, antibody-mediated rejection (with or without macroglobulinemia [Waldenstrom’s macroglobulinemia]) (with ABO compatible donors) or to desensitize a living donor with ABO or donor-specific HLA incompatibility Sydenham’s chorea Thrombotic microangiopathy, ticlopidine-associated thrombotic thrombocytopenic purpura Wilson’s disease, fulminant babesiosis, heavy: erythrocytes exchange Cutaneous T-cell lymphoma, erythrodermisch with Mykosefungoiden or Sezary syndrome: photopheresis familial hypercholesterolemia (homozygous): LDL-apheresis Hereditary hemochromatosis: Erythrozytendepletion hyperleukocytosis with Leukostasesyndrom: leukodepletion polycythemia vera: Erythrozytendepletion sickle cell disease with acute stroke: erythrocyte exchange II. Accepted as second-line treatment, either alone or in conjunction with other treatment methods antiphospholipid syndrome, severe autoimmune hemolytic anemia, cold agglutinin disease, life-threatening encephalomyelitis, acute disseminated familial hypercholesterolemia (homozygous with low blood volume) hematopoietic stem cell transplantation, wherein the receiver anti-A or anti -B antibody has that are incompatible with the donor (bone or peripheral blood stem cells) hemolytic uremic syndrome, because of a complement gene mutation Lambert-Eaton syndrome mushroom poisoning, heavy (eg. As death cap mushroom poisoning) multiple sclerosis, acute inflammatory myeloma (cast nephropathy) neuromyelitis optica, acute phytanic storage disease (Refsum’s disease) kidney transplantation, ABO-incompatible with humoral rejection SLE, heavy (eg. As cerebritis, diffuse alveolar hemorrhage) Voltage Controlled K + channel antibody (. eg neuromyotonia, limbic encephalitis, Morvan’s syndrome) babesiosis in high-risk patients (. eg immunosuppressed, age> 50): erythrocytes exchange cardiomyopathy, dilated (NYHA class II-IV): immunoadsorption cryoglobulinemia, heavy or symptomatic immunoadsorption familial hypercholesterolemia (heterozygous): LDL apheresis graft-versus-host disease, skin (acute or chronic): photopheresis heart or lung transplant rejection (treatment or prophylaxis): photopheresis lipoprotein A-hyperlipoproteinemia: LDL apheresis lung transplantation, all Ogene rejection (bronchiolitis obliterans syndrome): photopheresis malaria, severe: Erythozytenaustausch phytanic storage disease (Refsum’s disease): LDL apheresis sickle cell disease with acute chest syndrome, for the prevention of stroke (primary or secondary) or transfusionaler for the prevention of iron overload: Erythozytenaustausch thrombocytosis, symptomatic: Thrombozytendepletion Ulcerative colitis: adsorptive cytapheresis III. Meaning of apheresis is not secured; Decision should be made individually (approval by IRB desirable) ANCA-mediated, rapidly progressive glomerulonephritis (granulomatosis with polyangiitis), regardless of dialysis and without diffuse alveolar hemorrhage anemia, isolated aplastic anemia Aplastic anemia autoimmune hemolytic anemia, warm type resuscitation after burn shock cardiomyopathy, idiopathic dilated (NYHA class II-IV), clotting factor inhibitors, autoantibodies encephalitis, chronic focal (Rasmussen’s encephalitis), poisoning, Guillain-Barre syndrome (after iv immunoglobulin was added) heart transplant rejection (antibody-mediated) or desensitization in incompatibility due to donor-specific HLA antibody hemolytic uremic syndrome (associated with Streptococcus pneumoniae) immunoglobulin-A-associated vasculitis (Henoch-Schonlein purpura previously), Increasing or severe extrarenal disease heparin-induced thrombocytopenia (thrombosis or before cardiopulmonary bypass) Hypertriglyceridämische pancreatitis immune complex-mediated, rapidly progressive glomerulonephritis immunoglobulin A nephropathy (increasing or chronic progressive) liver failure, acute liver transplantation, ABO-incompatible (humoral rejection or for desensitization for a deceased donor) lung transplantation with antibody-mediated rejection of multiple myeloma with polyneuropathy multiple sclerosis (chronic progressive) Nephrogenic systemic fibrosis neuromyelitis optica, maintenance therapy paraneoplastic neurological syndromes pemphigus vulgaris, heavy Post-transfusion purpura Progressive multifocal leukoencephalopathy (PML), which is associated with natalizumab Progressive systemic sclerosis Erythrozytenalloimmunisierung (in pregnancy before intrauterine transfusion is available) kidney transplant with ABO compatibility (for desensitization, deceased donors with “high-panel” reactive antibodies) hearing loss, sudden sepsis with multiple organ failure Stiff-Person Syndrome Thrombotic microangiopathy associated with clopidogrel, cyclosporine or tacrolimus Thrombotic microangiopathy , refractory, with hematopoietic stem cell transplantation associated Thyrotoxic crisis Nekrolysis necrolysis, refractory clotting factor inhibitors (autoantibodies or alloantibodies): immunoadsorption Crohn’s disease: photopheresis Cutaneous T-cell lymphoma, nichterythrodermisch with Mykosefungoiden or Sezary syndrome: photopheresis encephalitis, chronic heavy (Rasmussen encephalitis): immunoadsorption erythrocytosis, secondary: Erythrozytendepletion hyperleukocytosis, prophylaxis of leukostasis: leukodepletion immune thrombocytopenia, r efraktär: immunoadsorption Inflammatory bowel disease (Crohn’s disease or ulcerative colitis): adsorptive cytapheresis multiple sclerosis, acute inflammatory: immunoadsorption graft-versus-host disease, not the skin on: photopheresis hematopoietic peripheral stem cell transplantation with minor ABO incompatibility (donor anti-A or anti -B antibody): RBC exchange Nephrogenic systemic fibrosis: photopheresis paraneoplastic neurological syndromes Paraproteinämische polyneuropathy with IgG / IgA, IgM (with or without Waldenstrom’s macroglobulinemia) pemphigus vulgaris: photopheresis Peripheral vascular disease psoriasis: photopheresis and / or lymphocyte depletion Inflammatory bowel disease: adsorptive cytapheresis Systemic sclerosis (scleroderma) sensorineural hearing loss sickle cell anemia with liver or Milzsequestrierung, intrahepatic cholestasis, multi-organ failure, priapism, a painful Found äßverschließende episode or prior to surgery: erythrocyte exchange Tacrolimusvergiftung: erythrocyte exchange IV Studies indication of adverse effect or no evidence of efficacy of apheresis.. Amyloidosis, systemic amyotrophic lateral sclerosis clotting factor inhibitors (alloantibodies) dermatomyositis or polymyositis hemolytic uremic syndrome, atypical by CD64 mutations or associated with Shiga toxin (diarrhea) immune thrombocytopenic purpura, refractory inclusion body POEMS syndrome (Plasmazellendyskrasie with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and Skin changes) psoriasis rheumatoid arthritis kidney, ABO-incompatible Thrombotic with group A2 / A2b to B, deceased donors schizophrenia SLE nephritis microangiopathy associated with gemcitabine or quinine dermatomyositis or polymyositis: leukapheresis inclusion body: leukapheresis ANCA = antineutrophil cytoplasmic Antikörpe r; IRB = Institutional Review Board (equivalent to the Ethics Committee in Germany); LDL = low-density lipoprotein cholesterol; NYHA = New York Heart Association. After Schwartz J, JL Winters, Padmanabhan A, et al: Guidelines on the use of therapeutic apheresis in clinical practice evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. Journal of Clinical Apheresis July; 28 (3): 145-284, 2013. doi: 10.1002 / jca.21276. Cytapheresis The therapeutic cytapheresis cellular components are removed from the blood and the plasma is returned to the patient. It is most commonly used to eliminate defective red blood cells and normal due. In patients with sickle cell disease, it is used for acute chest syndrome, stroke, pregnancy or frequent severe sickle cell crises. With the erythrocyte HbS exchange values ??of <30% can without the risk of increased blood viscosity, which may occur at elevated hematocrit by normal transfusions are achieved. The cytapheresis can be further used to treat a severe thrombocytosis or leukocytosis (cytoreduction) in acute leukemia or verschnellerter or leukemia in blast crisis phase of chronic leukemia and myelogen existing risk of bleeding. It also comes in the treatment of thrombosis and pulmonary or cerebral complications, which can occur when there is severe leukocytosis (leucostasis) used. The cytapheresis is effective in a thrombocytosis because platelets are not replaced as quickly as leukocytes. By 1 or 2 consecutive cytaphereses, platelet counts may be recycled to secure areas. With the leucocyte removal therapy (leukapheresis) several kilograms of leukocytes (buffy coat) can be removed with a few procedures, thereby leucostasis is reduced. Nevertheless, the reduction in white blood cell counts may even be only moderately and be temporary. In addition, the cytapheresis use in the collection of peripheral blood stem cells for autologous or allogeneic blood stem cell transplantation is (as an alternative to bone marrow transplantation) and in the collection of lymphocytes for use in antineoplastic therapy of an immunomodulatory (adoptive immunotherapy).