[Therapeutic apheresis: selective methods].

Abstract

Therapeutic apheresis is a term that describes numerous different procedures that remove pathological substances from the body. They are used in cases when conservative treatment measures fail, and may be useful as an adjuvant method for treatment of different diseases which have a common feature pathogenic protein substance (paraproteins, antibodies...) or pathogenic substance attached to proteins (toxins), that has to be removed from the body. These substances could be removed by nonselective (plasmapheresis and therapeutic plasma exchange), semiselective (cascade apheresis) or selective methods (different adsorption techniques). The best results are achieved by selective methods, while they remove only pathogenic substances (useful substances remain in plasma), do not require replacement fluid, and have significantly less complications. Different methods of therapeutic apheresis achieved good results in treatment of age-related macular degeneration, sudden hearing-loss, dilatative cardiomyopathy, cardiovascular and cerebrovascular diseases, hepatic failure, inflammatory bowel diseases, and different neurologic conditions like Guillain-Barre syndrome, multiple sclerosis and myastenia gravis. They are useful in renal transplantation for cases with positive crossmatch or AB0 blood group incompatibility, as well as for treatment of acute humoral rejection. Methods of therapeutic apheresis are save and efficient when performed by experienced personel, trained to prevent, timely recognize and treate possible complications.