In recent years, global clinical practicewidely used various methods of extracorporeal blood treatment for various diseases and pathological conditions involving severe toxicity, accumulation of pathological blood products - substances and support for confounding diseases.
We can distinguish three fundamentally differentdirection in the purification of blood: hemodialysis (using membranes with a certain bandwidth), hemosorption (perfusion of blood through the sorbents - activated carbon, resin) plazmatsitaferez in which under the influence of gravitational forces (sedimentation, centrifugation) whole blood stratified into components (for varying their density) and removed. This area became known as gravitational blood surgery.
Among the methods of gravitational blood surgery the mostwidespread use of plasmapheresis. The term "plasmapheresis" (from the Greek "apheresis" - delete), indicating a process of selective removal of the liquid part of blood (plasma), proposed in 1914 by J. Abel, use this procedure in the experimental development of artificial kidney in dogs. The idea of the clinical use of plasmapheresis, launched in 1925 N. Mikhailovsky, was based on the possibility of elimination (removal) from the body together with the plasma excess of physiological and pathological products.
Another fundamental aspect is the substitution of a remote plasma or the introduction of a full-fledged donors lack of blood components.
There are currently several methods of separating blood into components by gravity.
The simplest method of plasmapheresisIt is an ordinary blood sedimentation in bottles containing an anticoagulant (heparin, sodium citrate, prevents the development of blood clotting during her defending). Within 2-3 hours after the settling of cells to form two layers: the top - plasma, lower - red blood cells. Plasma is removed and the cells are returned to the blood flow to the patient. The method is called manual plasmapheresis; procedure takes a lot of time, the amount of removed plasma is small. Used it with blood diseases (paraproteinemic Leukemia), when the erythrocyte sedimentation rate is high.
Intermittent plasmapheresis usingplastikatnyh containers and refrigerated centrifuges has expanded the possibility of applying the method for therapeutic purposes. a simple method, easy to use, does not require expensive equipment, is easily tolerated by patients, different minimum number of complications, side effects. This is the most promising of all plasmapheresis methods used most often.
The procedure is as follows. Dotted ulnar Vienna, while poorly expressed subclavian venous catheterization system Vienna (by Seldinger technique). Blood enters the plastikatny container capacity of 500 ml, which is mixed with an anticoagulant. After filling with blood bag is disconnected from the needle (or catheter), instead joins vial of blood loss recoverable solution, administered in the same infusion vein. The bag at this time is centrifuged in refrigerated centrifuge (for 15-30 min at 2500- 3000 rev / min), after which it is removed from the plasma (300-350 ml). The remaining cell mass is diluted with saline solution (100-150 mL), and again through the same needle (or catheter) after disconnecting the vial with the recoverable solution is injected into the bloodstream of the patient. This procedure is carried out from 1 to 4 times per session, depending on many factors (the disease, the patient, the initial laboratory blood and other modifications.). Sessions are held in 1-3 day course of treatment is 1-5 sessions, session duration 1.2-3 hours.
It may be noted that patients are worried,worried only during the first session, and to the subsequent plasmapheresis procedures, especially with the appearance of clinical effect, calmly and with desire.
In the 60s a group of scientists of the National Institute(USA) has created a special blood separator (plasmapheresis machine). By centrifugation separation occurs in the rotor-cup at its various modes. Blood plastikatnye through tubular line via peristaltic pump fed into the depths, the rotor rotates at high speed, and the blood is separated into plasma and cellular elements (platelets, platelets, leukocytes, erythrocytes). Then (again using pumps) blood fraction from the rotor removed, the cells are returned to the patient.
Separators can work in a continuous mode,(Blood fills the cup, centrifuged and removed after a stop). Automatic method allows you to perform intensive plasmapheresis with the removal of large amounts of plasma (up to 3-4 liters per session).
The blood plasma constantly circulating antibodiesimmune complexes, metabolites of different cells (subject to removal from the body, intermediate - are important for normal functioning of the various cells and tissues), the components of the destroyed old and defective cells secreted their enzymes, local hormones, peptides and other substances, among which there are products with toxic effects: bilirubin, bile acids, endotoxins, kinins, trypsin, serotonin, etc. In normal digestion process occurs continuously and excretion of cellular substrates and products of the metabolism of the organism.. This process is disrupted in the pathology of cleansing organs (liver, kidney, spleen, lung), phagocyte defects - macrophagal system, as well as in the development and formation of excess products to be removed.
This is most pronounced in immune-complexpathology (it is based on a damaging effect on the fabric of circulating immune complexes), with massive burns (when the blood stream enters a large number of toxic substances from damaged tissues), acute infections, hemolytic processes (where blood cells are destroyed), radiation and cytostatic diseases. Inclusion of plasmapheresis in the complex therapy of these pathologies allows to obtain a very effective treatment results, and in certain cases it is even necessary to save the life of patients.
The mechanism of action of therapeutic plasmapheresisversatility. First of all, the direct removal together with the plasma of toxic products from the blood of the patient bed, the bacterial bodies and their toxins paraproteins, cryoglobulins, decomposition products of tissue destroyed blood cells circulating complexes of antigen - antibody, complement components, killer cells, lysosomal enzymes, kinins and other factors that determine the pathological process.
After plasmapheresis switched obschestimulyatsionnoeeffect blood loss (in ancient times it was seen by doctors: phlebotomy with a specific effect used in the treatment of various diseases), releases the nonspecific defense system, improves microcirculation in all parenchymal organs, reduced congestion in the capillaries and arterioles, improves tissue respiration, changes osmolarity and oncotic pressure plasma - there is thinning of blood (hemodilution) by plasma out of tissues.
Together with the plasma removed substanceadsorbed on the surface of red blood cells, improves the livelihoods cells, increases their functional activity, recovering the interaction with other cells, and regulatory factors.
In clinical practice, the toxic conditionsusing plasmapheresis achieved rapid detoxification: decreasing fever, decreases or disappears weakness, sweating, nausea, vomiting, asthenia, diarrhea, appetite is restored. In bronchial asthma - a subjective improvement of health, disappearance or decrease in frequency of asthma attacks, increased bronchial permeability, sensitivity to bronchodilators, remission, it is possible to reduce the dose of drugs, including hormonal agents, not only to reduce the dose, but in some cases, to abandon their application. In chronic bronchitis, respiratory failure decreased dyspnea, signs of inflammation, with difficult sputum improving its waste, reduced the frequency and severity of cough, increased physical activity, improves overall health. As in the case of asthma, bronchodilators sensitivity is restored, allowing the amount of the drugs from bottom. Remission - for 1 - 1.5 years.
Removal of plasma used in the therapydiseases, pathogenesis of which is of great importance in the accumulation of abnormal plasma part products, immune complexes, toxins, exogenous and endogenous protein structures.
Currently, there are about 50 suchdiseases: multiple myeloma, macroglobulinemia Valdenstrema, sclerosing limfotsitomy, acute leukemia, chronic myelogenous leukemia, and lymphocytic leukemia, autoimmune hemolytic anemia, hapten agranuliotsitoz, Henoch disease - purpura, systemic lupus erythematosus, drug allergy, rheumatoid arthritis, Goodpasture's syndrome, multiple sclerosis, chronic glomerulonephritis and pyelonephritis, chronic renal failure, asthma, pneumonia, staphylococcal destruction of lungs, chronic obstructive-purulent bronchitis with respiratory failure and others.
Plasmapheresis is prescribed to patients withresistance to conventional therapy, medication intolerance, developing complications from the drugs used in the acute stage of the disease (in order to break the progression of the disease and reduce the damaging effects of pathological agents). Plasmapheresis - a non-specific method of treatment, which increases the effectiveness of treatment in combination with other therapeutic measures.
Contraindications for plasmapheresis: severe anemia, renal, hepatic and pulmonary heart disease.
The frequency and nature of complications during plasmapheresisIt depends on the nature of the underlying disease, its complications, comorbidity. When removing large volumes of plasma popping hypotension (blood pressure lowering) and allergic reactions (when the remote plasma is replaced with the donor). Other complications with proper conduct of the procedure are extremely rare and have no special significance. In this regard, the best results are obtained with the method of using the intermittent plasmapheresis containers.