Articles

Plasmapheresis for neuropathies

A number of severe progressive neuropathies are based on the autoimmune pathogenesis, which is considered essential in myasthenia gravis, myasthenic Lambert-Eaton syndrome, Guillain-Barre syndrome, IgM-monoclonal demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, multiple sclerosis, inflammatory myopathies, syndrome of muscular hypertonicity, autoimmune neuromyotonia, paraneoplastic cerebellar degeneration and neuropathy, neuropathies associated with systemic vasculitis and viral infection. In these disorders autoantibodiesaffectglial cells, myelin, axon, calcium channels, muscles [DalakasM.C., 1995]. 

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THERAPEUTIC APHERESIS FOR DERMATOLOGY

There are many diseases of skin which are called “skin” only on visible symptoms of the illnesses. In all such cases the valid pathogenetic mechanisms of their development lie inside of an organism. As a rule, the autoimmune, allergic or toxico-allergic frustrations are the reasons of their pathology. And in all these cases therapeutic apheresis has to play a major role in their treatment.

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Plasmapheresis of pregnancy rhesus-conflict and haemolytic disease of fetus and newborn

Despite of introduction of anti-D prophylaxis into clinical practice, RhD alloimmunization still presents a problem to date. The purpose of this study was to determine the effectiveness of plasmapheresis and blood exchange-transfusion to diminish content of unconjugated bilirubin and free haemoglobin in newborn. The second purpose was to study the possibility of plasmapheresis in pregnant women to prevent hemolytic disease of the fetus and newborn (HDFN).

Subsequent clinical and laboratory investigation confirm that plasmapheresis was more effective and safe then blood exchange-transfusion (BET) to treat HDFN and plasmapheresis in pregnant women was rather effective to prevent HDFN.

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Plasmapheresis in transplantation

Despite all the advances in modern transplantation still remains the problem of acute or chronic rejection of transplanted organs. These processes have many reasons which can not always be eliminated.

In cases coming transplantation without removing the remaining autoantibodies in the body, the transplanted kidney is at risk of the same autoimmune destruction as remote. On the other hand, the removal of the affected kidney with "pseudo-heterogenous" antigenic structure that encourages the constant reproduction of autoantibodies may contribute to remission and this pathological process 

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Therapeutic plasmapheresis specialists training

Advances in efferent therapy depend not so much on the type of devices and from an understanding of the need for their use in various fields of medicine. It can even be called philosophy. That is what my book is devoted to the justification of the indications for plasmapheresis ("Efferent therapy. Membrane plasmapheresis", 2010).

Now specialists. This, of course, "piece goods". From whom they can form. Formally, in Russia, it is transfusiologist but ordinary transfusiologist nothing about the practice of medicine. The most well-workinghands andhead – this, is of course, reanimatolog (resustitator). Course should possess such qualities specialist for therapeutic aphetresis so that if necessary to ensure the restoration of all vital functions of man, dying from multiple organ failure, not to get lost in all the course corners of critical states. However, there are necessary knowledges in other fields of medicine – chronic diseases – allergies, autoimmune conditions, chronic intoxications etc. Specialist allergist, a rheumatologist will be good in their fields, and how to be a obstetrics, critical states. Here they will "float".

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Disturbances of surfactant activity and possibilities its correction in acute lung lesions

Special studies have shown surfactant activity disorders in the development of acute lung injuries, such as shock lung, respiratory distress syndrome (RDS), pneumonia, which plays an essential role in the development and severity of disease [1]. Surfactant, reducing the surface tension in the alveoli and thereby ensuring their stability on the exhale, and reduces the hydrostatic pressure in the pulmonary capillaries, preventing transudation of fluid from them [2]. Thus, the lack of surfactant leads to both atelectasis and pulmonary edema. The main active principle is a surfactant dipalmitoyl phosphatidyl choline, but there are protein components thereof, that is the surfactant is a lipoprotein synthesis that occurs in type II alveolocytes.

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Short instruction for membrane plasmapheresis

Line System Assembly

1.Open pinch valves on the device; take protective cap over pump segment off.

2.Open general package, then the package with line system, package with plasma off-take line, package with plasma collection container. Open the package with plasmafilter. 

3.Install plasmafilter in the its holder on support stand, red connection down.

4.Place line system on the device with singular pump outlet located on the right, and tubing with two fittings on the left.

5.Install pump segment (thick tube) into its channel in pump compartment.

6.Without sorting the tubing choose the tube going from the pump to plasmafilter, fix it in the first track of the right pinch valve, accurately mount the long end with the hydrophobic filter to the fitting of the manometer in the back part of the device, then fix this segment in the pin of the plasmafilter holder, and mount the shorter end to the lower (red) fitting of the plasmafilter.



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Therapeutic apheresis for sepsis

Despite all the advances in the treatment of infections and critical states, purulent- septic complications in surgery is one of the common causes of deaths. With considerable frequency of septic shock (in the U.S. - up to 500,000 patients per year, of which 100,000 die), this problem is extremely important. Mortality rate is 28.6%, and the cost per patient – $ 22.100. The general costs of caring for these patients in the United States account for 16.7 billion dollars [1].  In pediatric patients with sepsis number of such patients reaches 42,364 with case fatality rate of 10.3%. Treatment costs of one such child reach $ 40.600, and the total cost to 1.96 billion dollars a year [2]. In Western Europe, the cost of treating one patient with sepsis constitute 23.000-29.000 Euro [3]. All this underscores the importance and urgency of this problem, still waiting for their decision.

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Respiratory distress syndrome

Acute respiratory damages of lung parenchyma are frequent and serious complications in a number of diseases. First of all of it is referred to viral and bacterial pneumonia, which sometimes has a progressing course and is accompanied by  massive, sometimes total, bilateral damages of lung parenchyma with severe, hard correctable respiratory failure, which for several days, sometimes hours, can lead to death. Secondary to this there can develop destructive processes and even gangrene of the lungs.

The next group consists of acute lung damage, combined by the term "shock lung", developing in patients with severe trauma, who underwent surgery, including cardiopulmonary bypass on open heart (postperfusion pulmonary syndrome), hemorrhagic, septic or anaphylactic shock, massive blood transfusions (syndrome of "homologous blood"), leptospirosis and even tropical malaria with 57% letality  [Bhadade R.R. et al., 2011].

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Therapeutic apheresis in veterinary

A. By types of animals on the basis of anatomical and physiological characteristics of the structure of the most popular guess to use the device in the treatment of dogs and horses, to a lesser extent cats, and others small animals, taking into account the blood volume, the size of the peripheral veins, the commercial value of the procedure and the animal.

B. On the etiology of diseases: infectious and parasitic diseases (piroplasmosis, hemobartonelles, parvovirus enteritis) It needs to reduce toxicity with products of inflammation, drugs, immune complexes, to increase acceleration and percent recovery.

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Respiratory distress syndrome

Respiratory distress syndrome (RDS) – acute lung injuries – rather frequent and severe complications of acute pneumonia and other diseases (acute inflammatory diseases of the chest and abdominal cavities, severe traumas, burns, eclampsia, sepsis and other). RDS is the major causes of unfavorable outcomes, despite the use of most modern medicaments.

Our previous experimental studies have demonstrated that endotoxicosis developed in animals since first minutes of acute pneumonia modeling.There are many pathogenous factors of endotoxicosis: bacterial endo- and exogenous toxins, inflammatory toxic metabolites, products of proteolisis, activation of lipid peroxydation and decrease of anti-oxidation protection, toxic middle molecular weight compounds (oligopeptides), lysosomal enzymes.

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Therapeutic apheresis in the treatment of acute lung injuries

Acute lung injuries – respiratory distress syndrome (RDS) – rather frequent and severe complications of acute pneumonia and other diseases (acute inflammatory diseases of abdominal organs, severe traumas, burns, eclampsia, septical shock and other). RDS is the major causes of unfavorable outcomes, despite the use of most modern medicaments.

Our previous experimental studies have demonstrated that endotoxicosis developed in animals since first minutes of acute pneumonia modeling.There are many pathogenous factors of endotoxicosis: bacterial endo- and exogenous toxins, inflammatory toxic metabolites, products of  proteolisis, activation of lipid peroxydation and decrease of anti-oxidation protection, toxic middle molecular weight compounds (oligopeptids), lysosomal enzymes.

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Premature aging can be prevented

 
Human life can be divided into periods such as in football –
Halftime - 40 years
Second half - only 20 years old!
And then - "Overtime" that "Supreme Judge" will give it to you, or slash.
And it entirely depends on the person.
If during the first half, much can afford – and drinking, and smoking, and there is how much and what you want, then the age of fortypeople should stop, look back and imagine – how he can live and for how long, and in what condition. And the "win" if he himself is the extra time! Will it be in the future mainstay of the family, children and grandchildren, and to himself, or will only be a burden to them, while in the best case in a wheelchair, or even bedridden.

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Therapeutic apheresis in cosmetology and plastic surgery

From the viewpoint of problems of plastic surgery, tasks therapeutic apheresis it is seen following:

1 Plastic surgery should be performed in patients who are otherwise in full health – that is, with a minimum of health problems and with an adequate level of immune protection. Plasmapheresis in such cases will restore the immune system and correction of previous health problems (correction of atherosclerosis, improving the functional state of the liver, especially if it is not especially when life was spared and spilled alcohol, etc.).

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Plasmapheresis in a wide range of diseases

Many human diseases are accompanied by disturbances of structure of the internal environment which define the severity of a clinical course in many aspects and even may become principal reasons of failure, despite the usage of advanced modern medicamentous means or surgical treatment. Such problems arise during sharp inflammatory diseases of thoracic and abdominal cavity organs, serious traumas and burns injuries, poisonings and infectious diseases when the syndrome of endogenous intoxications with suppression of system of immune protection starts to develop. In this situation detoxication both with toxins extraction and other pathology process products allows to achieve crisis in the course of the illness.

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Plasmapheresis in the treatment of acute pancreatitis

Despite of improvements in surgical methods of treatment using the latest anti-protease drugs, treatment of acute pancreatitis is still a difficult problem and is accompanied by a relatively high mortality. This largely depends on what is the disease is at the presence of severe endotoxemia on the basis of sharp increase of proteolytic enzymes and the resulting on increase in the content of some toxic average molecular weight substances, activation of lipid peroxidation with the suppression of the antioxidant defense system. In this first liver takes the brunt of the enzymes in the blood washed out of the pancreas, to a certain point, retaining the ability to inactivate them, and then comes defeat and its functions of detoxification, which defines the transition to the decompensated phase of endotoxemia, increases the level of transferases, amylase, phenol, ammonia, fatty acids and other toxic metabolites. Can join respiratory distress syndrome, which is a toxic pulmonary edema with the development of severe parenchymatous respiratory failure.

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The choice of methods of therapeutic apheresis in multiple organ failure

Extracorporeal detoxification methods, immuno- and reocorrection are an integral part of therapeutic measures in the broadest range of diseases associated with severe endogenous intoxication .

In acute inflammatory diseases of the thoracic and abdominal cavities – severe pneumonia, abscesses and gangrene of the lung, mediastinitis, acute pancreatitis, peritonitis of different etiology, infectious diseases, as well as extensive burns and severe trauma, "crush syndrome", sepsis and eclampsia accumulation of endogenous toxins largely determines the severity of pathology and general outcome of disease. Thus even timely surgical intervention and the most modern medicines and broad-spectrum antibiotics are not able to eliminate the severe endotoxemia and restore immune defense system in such patients. 

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Plasmapheresis in ophthalmology

Many eye diseases are autoimmune nature and are accompanied by the accumulation of autoantibodies as well as other pathological metabolites, the large size of the molecules which do not allow them to remove them through kidneys and in violation of the processes of their degradation. Removing them is possible only with the liquid portion of blood - plasma during plasmapheresis, which allows to treat such diseases more efficiently.


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Plasmapheresis during radiotherapy of pancreatic cancer an -its -possibilities in cancer chemotherapy

In recent decades it has seen an increase in the incidence of pancreatic cancer (PCa). Since 1940, the incidence of PCa has increased by 4 times, reaching 11 per 100 thousand of population. In the U.S., PCa is the fourth leading cause of death fr om all cancers, taking more than 20 thousand persons a year. In Russia, the incidence of PCa in 1995 was 8.6 per 100 thousand of population, while in Moscow – 11.4. In pancreatic carcinoma it accounts for 10% of all tumors of the digestive tract [1].

Radical treatment is possible only in 10-15% of patients. Most patients (90%) die within a year after diagnosis. In 80-85% of cases diagnosed with PCa at a stage wh ere there is already an outside pancreas spread of tumors, while 40% – distant metastases [1].

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Plasmapheresis in obstetrics and neonatology

Humanhealthisestablishedevenintheperiodofitsprenataldevelopment.Many researchers in their studies indicate an association of various diseases in children, especially such as allergies (including atopic dermatitis, bronchial asthma), chronic bronchitis, kidney disease, with disorders of pregnancy of their mothers.In obstetrics is important not only to ensure optimal conditions and the security of the delivery, but also to create favorable conditions for the development of the fetus throughout pregnancy. Despite all the achievements of modern health care, there is still a high enough level of threatened abortion and preterm birth, perinatal morbidity and mortality. And all this was the basis for study of the causes and pathogenesis of the major complications of pregnancy, the development of measures of prevention and treatment.

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Efferent therapy of neuropathies

A number of severe progressive neuropathies are based on the autoimmune pathogenesis, which is considered essential in myasthenia gravis, myasthenic Lambert-Eaton syndrome, Guillain-Barre syndrome, IgM-monoclonal demyelinating polyneuropathy, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, multiple sclerosis, inflammatory myopathies, syndrome of muscular hypertonicity, autoimmune neuromyotonia, paraneoplastic cerebellar degeneration and neuropathy, neuropathies associated with systemic vasculitis and viral infection. In these disorders autoantibodiesaffectglial cells, myelin, axon, calcium channels, muscle [DalakasM.C., 1995].

Demyelinating diseases are widespread in the population with an unstoppable trend to "rejuvenation", with rapid incapacitation and uniquely poor prognosis. Demyelination is due to release of control of T-suppressors with the abolition of immune tolerance to myelin basic protein (MBP). Antibodies against MBP stimulate complement which increases the permeability of the blood-brain barrier to components of the immune system. Antibodies to MBP, specifically affecting the oligodendrocytes and myelin, have myelinolitic and myelinotoxic effects. During the incubation of these antibodies with allogenic MBP a pronounced proteolytic effect is revealed[Vostrikova I.L. and others, 2006].

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Plasmapheresis in nephrology

Almost all chronic kidney disease in varying degrees, are associated with disorders of the internal environment, mainly autoimmune nature. Drug therapy is not always effective and can lead to additional disorders. Pathogenetically justified is the use of plasmapheresis.

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Plasmapheresis for miscarriage and infertility

The problem of miscarriage is one of the most urgent problems of obstetrics. Its frequency is 15-20% of all pregnancies, and the frequency of infertility – in 5-11% of marriages [Kon'kov D.G. et al., 2008]. 30-40% of these abortions are "unexplained» [Kutteh W.H. et al., 1999].

Among the etiological factors observed anatomical abnormalities of female genitalia, chromosomal pathology, infectious disease, neuroendocrine pathology, antiphospholipid syndrome. We shall mention only those in the elimination of which can be used apheresis therapy, especially using plasmapheresis.

Virtually all of the above complications of pregnancy to some extent also threaten miscarriage or premature birth. This is also characteristic of preeclampsia and revitalization hidden genital infections, and Rh-conflict. In all these cases the pathogenesis of disorders is reduced to the accumulation in the body of a pregnant pathological products and apheresis therapy that promotes their excretion, and provides the best conditions for the continuation of pregnancy.


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Plasmapheresis for metabolic syndrome

Metabolic syndrome of insulin resistance factor combines with the development of diabetes, hypertension and obesity. Accompanied by the accumulation of various pathological products infringing microcirculation and blood flow in the vessels of the heart, brain, kidney, eyes and peripheral arteries. Drug therapy is not always able to eliminate such complications and to the forefront apheresis therapy mainly plasmapheresis.

Keywords: Metabolic syndrome, diabetes, circulatory disorders, plasmapheresis.

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Efferent therapy in cases of malaria

Today, like 150 years ago, malaria remains one of the most common diseases in the world, every year affecting up to 500 million people. Of the four species of malaria, tropical is characterized as the most severe, and deaths caused by it make up 98% of all deaths from malaria [1]. In India, malaria causes deaths of more than 15,000 children per year, and in sub-Saharan Africa - more than 200,000 children.

The severity of the clinical course of falciparum malaria (FM) is due to many reasons, including the presence of specific toxic factors (e.g. cytotoxic substance Megreta) in this species of parasites (Plasmodium falciparum), manifestation of tissue anaphylaxis, often associated with more pronounced immunoreactive properties of the waste products of this type of plasmodium. The released substance in the blood activate macrophages and lead to the release of pro-inflammatory cytokines (TNF, IL1β, IL2), which determine the severity of endotoxemia.

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Plasmapheresis for the treatment of idiopathic pulmonary fibrosis

The interstitial pulmonary diseases are made by 10–15% in structure of all diseases of lungs. More than 130 diseases of a known and unknown etiology concern to them. One of the most widespread and predictively adverse diseases is the idiopathic pulmonary fibrosis (IPF) [3].

IPF – a disease in which development the main role is played by immune mechanisms to what presence of the activated lymphocytes and macrophages in lungs testifies. Essential deviations from norm are defined and in system of humoral immunity. Immunoglobulins of three main classes (A, G and M) and the circulating immune complexes (CIC) serve as criterion of intensity of autoimmune processes in an organism [3, 5]. Therefore research of changes of indicators of the immunological status at IPF is important in the solution of questions of medical tactics.

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Membrane Plasmapheresis

Line System Assembly

  1. Open pinch valves on the device; take protective cap over pump segment off.
  2. Open general package, then the package with line system, package with plasma off-take line, package with plasma collection container. Open the package with plasmafilter.
  3. Install plasmafilter in the its holder on support stand, red connection down.
  4. Place line system on the device with singular pump outlet located on the right, and tubing with two fittings on the left.
  5. Install pump segment (thick tube) into its channel in pump compartment.

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Therapeutic apheresis for infectious diseases

According to WHO in the world of infectious diseases killed every day, up to 16 million people. 30-50 million infections annually registered in Russia. Of these, 10-12% of patients requiring intensive care as a result of infectious toxic shock, toxic encephalopathy and damage other vital organs. The best results are achieved in the presence of intensive treatment before the onset of the critical state [Pokrovsky V.I., 2005].

Virtually no infectious diseases that would not be accompanied by significant intoxication, the latter usually determine the severity of the state, as the main mechanism tanatogenesis significantly affecting the overall outcome. The structure consists of endotoxemia bacterial endo- and exotoxins, products of inflammation and tissue destruction from primary foci of inflammation entering the circulation, secondary metabolic disorders such as, as mentioned above in the description of septic complications.

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Therapeutic apheresis in infectious diseases

Virtually no infectious diseases are not accompanied by a significant intoxication, and, usually, it determines the severity of the condition being the main mechanism tanatogenesis significantly affecting the overall outcome. The structure consists of endotoxemia bacterial endo-and exotoxins, products entering the circulation of inflammation and tissue destruction of the primary foci of inflammation secondary metabolic disorders such as, as mentioned above in the description of septic complications. 

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Plasmapheresis for chronic hepatitis

Chronic hepatitis B is one of the most severe types of autoimmune diseases. It is known that after the acute hepatitis B chronicity occurs in 5-10% of patients, and according to U.S. statistics in the U.S. the number of patients with chronic hepatitis B was 1.25 million people. At the same time, deaths from chronic hepatitis B in 5 to 10 times higher than from acute, entering the top ten causes of death, 50 times greater than the frequency of deaths of HIV infection. 

On the scale of the Earth are infected with hepatitis B virus more than one third of the population (approximately 1 billion people) and about ¼ of them will develop chronic hepatitis, cirrhosis and primary liver cancer. Thus 2.1 million people die annually. In Europe, each year 1 million people are infected, of which about 90,000 will be chronically ill and 22,000 will die from cirrhosis or cancer.

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Biospecific hemosorption on the device Hemofenix

Therapeutic apheresis is increasingly used in clinical practice. Many human diseases are accompanied by disturbances of the internal environment, which largely determine the severity of the disease and even are the main causes of adverse outcomes, despite the use of the most modern medications or surgery. Such problems arise in acute inflammatory diseases of the thoracic and abdominal cavities, severe trauma and burns, poisoning and infectious diseases, when the syndrome of endogenous intoxication is arise. Under these conditions, detoxification with endotoxins and other pathological products removal allows to achieve a breakthrough in the course of the disease.

This primarily relates to acute pancreatitis, which occurs on a background of severe endotoxemia on the basis of a sharp increase in the level of proteolytic enzymes and the resulting increase in the content of an average molecular weight substances, activation of lipid peroxidation with the suppression of the antioxidant defense system. In this case, the liver first takes the brunt of the enzyme eluted into the blood from the pancreas, to a certain point, while maintaining the ability to inactivate them. Then comes the depletion of its detoxifying function, which determines the transition to the decompensated phase of endotoxemia with the increase in the level of transferases, phenol, ammonia, fatty acids and other toxic metabolites.

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Plasmapheresis in prevention of renal lesions in the elderly

With age increases the risk of renal lesions associated with disorders of biochemical and immune homeostasis.

In particular, the growing number of patients suffering from the metabolic syndrome with disorders of lipid metabolism, hypertension and type 2 diabetes. All this is accompanied by the development of diabetic nephropathy, which is often as severe, requiring hemodialysis. Despite the maintenance of blood sugar levels, thus there is microvascular endothelial damage accumulating substances which are not amenable to drug therapy.

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Therapeutic apheresis in the prevention of premature aging

There is no doubt that the biologically predetermined person's age is not less than 110 years, and according to some reports should reach 150 years, although in reality the average life expectancy does not exceed half of that period. Was it ever a golden age of mankind, when people lived to this age, as evidenced by the biblical sources, hard to say. On the other hand, there are those evidence that ancient man lived an average of about 40 years.

Course of illness, injury peacetime and wartime significantly shorten the period of life. If a person for life even avoid any diseases and injuries, anyway, he will inevitably die "of old age." But why in some cases the "old age" carries 60-year-olds, and other 90-year-old spared ? What is the basis of aging?

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Therapeutic apheresis for genital infections in obstetrics

Development of the fetus at risk of intrauterine infection in the presence of a pregnant syndrome hidden urogenital infections – chlamydia, mycoplasma, ureaplasma, toxoplasmosis, gardnerella infection, herpes viruses and cytomegalovirus lesions.

During the life of women before pregnancy, these infections may not cause significant illness and manifested by periodic exacerbations cystitis adneksitis, vaginitis. However, during pregnancy, the main danger is the fetus, causing defects and violations of its development up to the termination of pregnancy in the early stages (ie, in fact infertility), premature birth, and even fetal death. However, the born alive child has signs of intrauterine and postnatal infection (45%), morphological and functional immaturity and intrauterine growth retardation (18%), serious disorders of the brain (23%), liver, kidneys, lungs.

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Indications and possibility of using membrane plasmapheresis in emergency medical care

With a wide range of natural and man-made or transportation disasters it is possible serious injury with "crush" syndrome and burns when developing heavy endotoxemia. It occurs due to the accumulation in ischemic tissues not oxidized metabolic products, mainly lactic and pyruvic acids. There is developed necrosis of muscle fibers. With burns there are also occur extensive tissue necrosis, destruction of red blood cells (hemolysis) within the vessels adjacent to the burned area, with the release of free hemoglobin.

When blood flow restored in the vascular system is beginning to enter these toxic products. At the same time as free hemoglobin and myoglobin, released from the breakdown of muscle fibers, in the allocation of kidneys at acidic urine are precipitated in the form of hydrochloric acid hematin or myoglobin, completely blocking the renal tubules, which are not able to unlock even hemodialysis.

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Efferent therapy

Plasmapheresis is one of the forms of efferent therapy intended to eliminate from the organism various pathological products (the Latin efferens - elimination). These methods existed in ancient times already – use of diuretics, emetics, purgatives, choleretics, diaphoretics.

In the past, rather popular was such a form of efferent therapy as bloodletting which apart from eliminating excessive circulating blood volume (CBV) released the organism from toxic elements. Even barbers were allowed to perform it. However, even in hands of experienced doctors this method was not deprived of hazards, so much the more the history knows the cases of failures of such procedure. 

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Plasmapheresis for critically ill patients

Efferent therapy is intended to eliminate from the organism various pathological products (the Latin efferens – elimination). In the past, rather popular was such a form of efferent therapy as bloodletting which apart from eliminating excessive circulating blood volume (CBV) released the organism from toxic elements. Even barbers were allowed to perform it. However, even in hands of experienced doctors this method was not deprived of hazards, so much the more the history knows the cases of failures of such procedure.

More safe method of efferent therapy is the removal of not the whole blood, but of its liquid part – plasma, components of which are the main carriers of pathological products in the organism, what’s more, it is restored much quicker than blood formed elements. This particular method is called plasmapheresis (from the Greek πλάσμα - plasma, liquid part of blood, and ἀφαίρεσις - aphairesis, taking away). In this context "apheiresis" is from the Greek “removal” either. 

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Ecology and pregnancy

It is known that in cities with large industrial enterprises, especially the chemical industry, the levels of perinatal mortality and morbidity is significantly higher than the national average, being one of the causes of the decrease of population growth. Environmentally dependent pathological processes are the cause of fertile decline, risk of gestational complications, fetal malformations and miscarriages, reduce the reproductive potential of the nation [Vdovenko I.A. et al. 2013]. It should be added to this the dramatic reduction in the category of healthy children, which has not only medical, social, demographic, but also economic importance. 

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Diabetic foot syndrome

Diabetes mellitus has spread from 2.5 to 3.8% of the population with a doubling of the number of patients every 10-15 years. Among those older than 70 years have diabetes occurs in 10% of cases [1]. In Russia – about 10 million people with diabetes [2]. Diabetes mellitus type 2 is found in 10-20 times more common than diabetes insulin-dependent.

In diabetes increases sharply production of modified glycated low-density lipoproteins (LDL). Formation of immune complexes with glycated LDL increases their atherogenicity and contributes to the progression of atherosclerosis.

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Dengue Fever

Manifestations of dengue fever - arthralgia, respiratory failure, organ disorders, haemorrhage with thrombocytopenia - are largely determined by heavy endotoxicosis with increased permeability of the vascular endothelium with the release from the vascular bed in tissues of not only fluid but also protein. It develops a toxic edema of the lungs that leads to respiratory distress with severe respiratory failure, in the liver - to toxic hepatopathy, in the brain - a toxic encephalopathy. Toxins damage the membranes of platelets, contributing to their increased adhesive activity with the formation of microaggregates, which is the first phase of development of disseminated intravascular clotting syndrome with thrombocytopenia and hemorrhagic manifestations (skin - hemorrhagic rash, stomach - vomiting blood, kidneys - oligouria and hematuria, etc.).

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Plasmapheresis for Chagas’ disease

Chagas' disease is a chronic disease of the heart, struck more than 16 million people in the Americas and the resulting infection of the protozoan parasite Trypanosoma cruzi. After the acute phase of the disease, which is manifested esophageal bleeding, often 20-30 years revealed lesions of the esophagus (dilatation), colon (megacolon) and hearts with the development of inflammatory cardiomyopathy with severe dilatation of the cavities of the heart, congestive heart failure and death.

Histological examination revealed a diffuse myocarditis with degeneration of cardiomyocytes, combined with fibrosis, mononuclear infiltration and damage elements of the conduction system of the heart in the absence of parasites themselves [Mirkin GA et al., 1997]. These data suggest a large percentage of the probability of an autoimmune pathogenesis of this disease. Autoantibodies effect on G-protein receptors of the myocardium such as b-adrenoceptors and M2 acetylcholine receptor.

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Plasmapheresis for autoimmunity

Over the past four decades, increased awareness that many human diseases are linked, at least partly, with disorders of the immune system, which functions instead of inherent protection of health and life itself of the body, allows self-destructive immune processes. There is plenty evidence confirming that autoimmune concept. Well known and triggers that provoke these processes – such as infections, foods and even drugs. The antibodies and lymphocytes in patients show responses to specific structures of the body, such as cell nuclei and the receptors or tissue, such as collagen, or muscle.

Immune complexes were detected in the circulation and in certain places, especially in the vascular wall, are the initiators of the immune response to inflammation or atopy. Some etiological mechanisms such as endocrine, genetic, infectious, environmental, as well as the aging process, are participants in the development of the set of autoimmune diseases (1).

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Plasmapheresis for atherosclerosis

Atherosclerosis is perhaps the most frequent and severe human disease. It is accompanied by vascular disorders, which are the main causes of lipid metabolism lead to the accumulation of low-density- and very low-density cholesterol, triglycerides while reducing the content of anti-atherogenic factors - high-density lipoprotein (HDL). All further consequences –  deposition of atherosclerotic plaques in the vessel walls with narrowing of the lumen is quite well known, as well as their main symptoms: narrowing of the coronary vessels – coronary heart disease, cerebral vascular narrowing with ischemic attacks, peripheral vasoconstriction, leading to gangrene of the extremities.

Nevertheless, in the pathogenesis of atherosclerosis a certain role plays and autoimmune factors. This primarily refers to the anticardiolipin antibodies. In addition, there are identified IgG-antibodies to vascular endothelium, cardiomyocytes, cardiac conduction system fibers and smooth muscle.

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Plasmapheresis in the treatment of antiphospholipid syndrome

1. Antiphospholipid syndromein general somaticpractice
 
Recently, there is growing interestin thisautoimmunevascular diseasethat manifests itselfinthe developmentof recurrentthrombosisof the venousand arterialsystemsof various organs[1]. The frequency ofpulmonary embolismas a resultof deep vein thrombosisreaches500,000cases per year, most of which are fatal. Insidiousnessof these complicationsisalmost completelyasymptomaticduringtheirup to the timeof thromboembolism in50% of patients[2]. Deep vein thrombosisis often(up to 29%) develop also after surgery, and after surgery for malignanttumorsthe frequencyreaches66%[3].

Most oftenit is a questionofantiphospholipid syndrome, first describedin 1983G.R.Hughes [4]. Antiphospholipid (aPL) antibodies areheterogenous groupof autoantibodies withdifferent properties, including differentspecificphospholipid-associated proteins, as well as reactivephospholipidmolecules. There are basic proteins, which are considered as antigensb2-glycoprotein I,prothrombin,protein C, proteinS,kininogen, annexinV.The various mechanismsinvolvedin the pathogenesisof aPL syndrome, including the effect ofaPLautoantibodiestoproteinCsystemandantithrombinIII, as wellasplatelets, endothelialcells andmonocytes[5, 6].

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Plasmapheresis in allergies

Increased incidence of allergic diseases (up to 20% of the population) is the result of human contact with the growing number of allergens: industrial (turpentine, nickel, chromium, tar, varnishes, resins, tannins, etc.), food (eggs, citrus fruits, tomatoes and chemical additives), vegetable (ragweed pollen, timothy grass, etc.), household (house dust, perfumes, detergents, synthetic fabrics), agricultural (insecticides, pesticides, defoliants, fertilizers), medicines (penicillin, sulfonamides, aspirin, etc.).

Occurrence of allergic diseases there are due to imperfection of the biotransformation allergens in the microsomal liver unit (appearance of secondary reactive compounds) and with defects of the immune response (atopic forms), biotransformation and elimination of immune complexes.

Atopy seems as overreaction of the immune system against common and harmless environmental substances. Allergic antibodies are immunoglobulin E (IgE). IgE production by B-lymphocytes is stimulated by cytokines IL-4, IL-5 and IL-13 secreted by T-helper lymphocytes influenced allergens [1, 2]. Communication IgE-antibodies to allergens (antigens) generates involving complement persistent immune complexes, the elimination of which is difficult in allergy. Some of them are still in circulation (circulating immune complexes or CIC), and the rest are fixed in the interstitium of target organs, stimulating there the immune or allergic inflammation. Among these target organs occupies the leading place bronchial tree, skin and mucous membranes of the nasal cavity. 

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Therapeutic apheresis in addiction

Underlying diseases of this profile is a psychological dependence – addiction to alcohol, drugs or certain pharmacological or toxic substances (substance abuse). However, in the body thus arises also some kind of metabolic processes violation, the normal flow which is impossible without the inclusion of the substances or their derivatives. Depriving them induced severe withdrawal syndromes, often with fatal outcome. In all cases there is a severe mental disorders – hallucinations, delusions, phobic state, often pushing these persons to the crime.

Alcoholism (alcohol disease) is the most common type of addiction. According to various statistical studies of them suffer from 4 to 45% of the population. It is believed that dose daily use of alcohol (in terms of absolute alcohol) 20-60 grams for men and 10-40 grams for women are relatively safe, but the real need of the organism in alcohol does not exceed 10 grams per day, and it is entirely covered at the expense of endogenously produced alcohols, like most of our “smaller brothers” – animals, which none, even the most careful owner, does not consider it necessary to add to their daily diet of any alcohol additives.

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Therapeutic apheresis in the treatment of acute lung injuries

Acute  lung  injuries — respiratory  distress  syndrome (RDS) — rather  frequent and severe complications of acute pneumonia and other diseases (acute inflammatory diseases  of  abdominal  organs,  severe  traumas,  burns,  eclampsia,  septical  shock and other). RDS  is  the  major  causes  of  unfavorable  outcomes,  despite  the  use  of  most modern medicaments. 
 Our previous experimental studies  have  demonstrated that endotoxicosis developed  in animals  since  first  minutes  of  acute  pneumonia  modeling.  There  are many  pathogenous  factors  of  endotoxicosis:  bacterial  endo- and  exogenous  toxins, inflammatory   toxic  metabolites, products of  proteolisis,  activation of  lipid peroxydation  and  decrease of anti-oxidation protection,  toxic  middle molecular weight compounds (oligopeptids), lysosomal enzymes.

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A. By types of animals on the basis of anatomical and physiological characteristics of the structure of the most popular guess to use the device in the treatment of dogs and horses, to a lesser extent cats, and others small animals, taking into account the blood volume, the size of the peripheral veins, the commercial value of the procedure and the animal.
B. On the etiology of diseases: infectious and parasitic diseases (piroplasmosis, hemobartonelles, parvovirus enteritis) It needs to reduce toxicity with products of inflammation, drugs, immune complexes, to increase acceleration and percent recovery. Internal no infectious diseases: often arising in connection with the not right content and feeding the animals (various kinds of allergic dermatitis, atopy, chronic and acute disorders of the liver and kidneys in dogs; breed, genetically transmitted disease, "Shar-Pei Fever" porto-caval shunt of Yorkshire Terriers, rheumatoid lesions hooves and chronic obstructive pulmonary disease in horses).

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Membrane plasmapheresis in sports medicine

Loadings of "big-time sports" not always highly affect a state of health of athletes, so and their sporting achievements. Matter not only systematic, but also short-term overloads during the trainings or competitions. In particular, at skaters and swimmers concentration of a tumor necrosis factor (TNFα) increased in the training period by 50-100 times that exceeds the level of this cytokine at patients with septic shock. Thus, even in the rehabilitation period its contents wasn't restored to norm (1). 

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