Therapeutic apheresis.Plasmapheresis. 

The plasmapheresis allows to deletes such substances which an organism itself isn't able to remove from. It is, mainly, about the large molecular products which can't be removed with kidneys, and they can be removed only together with liquid part of blood – plasma, and the term came from the Greek - πλάσμα – plasma and ἀφαίρεσις – apheresis or removal.

Many human diseases are accompanied by violations of the internal environment, which largely determine the severity of disease and even are the main causes of adverse outcomes, despite the use of the most modern drugs or surgical procedures.

ACUTE DISEASES AND PATHOLOGICAL CONDITIONS.

First of all we are talking about the septic shock complicated by and for acute inflammatory diseases of the chest and abdominal cavity. In these cases, the development of heavy endotoxicosis depends on endo- and exotoxins of wafting from the primary source of infection in the bloodstream, as well as the development of a chain of subsequent metabolic disorders with the accumulation of toxic end products, tissue hypoxia with release of not fully oxidized substances.

At pancreatitis activization of a proteolysis is followed by washing away in blood from a pancreas of a significant amount of enzymes. At peritonitis, besides emission of endotoxins of colibacillus and other activators, high soaking-up ability and the big area of a peritoneum, paresis of intestines is followed by activation of putrefactive fermentation with increase of permeability of an intestinal wall for the enterogenous toxins. At a traumatic illness the syndrome of endogenous intoxication develops from the earliest stage owing to primary "a stress storm" of various biological active agents arising at traumatic shock, absorption in blood of fatty inclusions, products of tissue disintegration and the subsequent inflammation.

In all these cases the collecting toxic substances promote violation of permeability of cellular membranes. Porosity of vessels walls stimulates an exit from the vascular course in interstitial space not only liquids, but also proteins. Toxic edema is the main reason of respiratory distress syndrome formation and of other vital organs defeats as is the main reason for death of the person in such cases.

From brought it becomes clear that only the detoxication or removal of toxic substances from an organism is able to break the course of a disease and to achieve recovery.

However in the majority of the complications described above the fact of their emergence speaks about initial insolvency of systems of protection. Endotoxicosis development in even bigger degree aggravates this "secondary" immunodeficiency. After primary tension there comes exhaustion and a full decompensation of mechanisms of immunity. Medicamentous immunostimulation isn't able to restore these "exhausted" and oppressed mechanisms of immune protection. Until the person starts struggling actively with infectious and any other agents, even the most modern medicines and antibiotics of "the fifth or sixth generation", are incapable to break a course of disease. 

Thus only plasma exchange with a full recovery of the deleted plasma (in volume to 2-3 liters) on donor plasma with all full-fledged components of the humoral immunity which is able not only to remove the circulating toxic substances but also at once to lift the general protective potential of patients that promote faster and permanent recovery.

CHRONIC DISEASES

The majority of chronic diseases are also followed by accumulation of pathological products – autoantibodies and also immune complexes, allergens and atherogenous factors and other pathological metabolites which in many respects determine the scale of manifestations of an illness and impossibility of an absolute recovery. Among such diseases are bronchial asthma and other manifestations of an allergy, system autoimmune diseases, rheumatism and glomerulonephritis, a hypertensive illness and angina pectoris, a number of skin and nervous diseases. Usual medical actions have generally symptomatic character, that is only soften visible clinical manifestations, without affecting the main pathogenetic mechanisms of diseases development.

It must be kept in mind that processes of presenilation are also connected with emergence and accumulation of a row autoantibodies and other toxic metabolites which timely removal can smooth in many respects involute processes and postpone developing of diseases of "advanced age".

We accepted "softer" tactics of a therapeutic plasmapheresis – on 3-4 sessions every other day with removal to 30-40% of the circulating plasma volume (CPV) that it is possible to replace only with "water", without attraction of donor plasma and other its components, the warning risk of transfer of viral infections. However for all course more than 1-1,5 CPV will be removed.

It is necessary to consider that the system of regulation of structure of the internal environment of the body immediately starts the mechanism of completion of the deleted ingredients, however at undisturbed genetics generally normal components restored which in the "refreshed" and deprived of toxic "press" of the internal environment of the body keep properties inherent in them more long jump out. Process of accumulation of pathological products more gradual, takes weeks and months. Therefore if etiology factors of diseases aren't liquidated, conducting repeated courses in 5-7 months, it is possible to hold patients at rather operated remission level, in due time warning crises of heavy complications.

Of course, at different chronic diseases the most various types of violations of a biochemical and immune homeostasis develop, however it essentially doesn't influence tactics of therapeutic apheresis though in all cases overdue its application isn't able to liquidate the come organic defeats of tissues complications. On the other hand, at early stages it is quite possible to prevent irreversible organ frustration. Moreover, preventive procedures of a plasmapheresis can distance prospects of development of many types of autoimmune diseases, atherosclerosis and even the premature old age.



Case studies
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