Blood purification (plasmapheresis): indications and contraindications. Get plasmapheresis in Moscow

Plasmapheresis is a method of efferent therapy with which doctors influence the internal environment of the human body. It quickly and effectively cleanses the blood of exogenous and endogenous toxic substances. This procedure is successfully used in the Yusupov Hospital to treat a number of diseases of various systems and organs. Thanks to the latest equipment and the extensive experience of the highly qualified medical staff of the intensive care unit, plasmapheresis is carried out at the highest level. The risk of complications is minimal.

Doctors at the Yusupov Hospital determine the number of plasmapheresis sessions by objectively assessing the patient’s condition and establishing the goal of treatment. Often, noticeable improvements are observed after the first procedure. But sometimes it is necessary to conduct at least five sessions, the schedule of which is developed by a specialist. Most often, the plasmapheresis procedure is performed as part of complex therapy.

Principle of plasmapheresis

Plasmapheresis is a gravitational method of extracorporeal detoxification (blood purification outside the human body). During centrifugation, centrifugal forces act on the blood. The shaped elements are arranged in layers around the axis of rotation. The densest cells (erythrocytes) move to the periphery. Closer to the center are the formed elements of blood, the density of which is less (leukocytes and platelets).

Pure plasma remains in the center of the separation chamber. In the case of therapeutic plasmapheresis, it is removed entirely, with all the physiological and toxic components it contains, and replaced with fresh frozen donor plasma or blood substitutes. Thanks to cooperation with large blood banks in Moscow, the Yusupov Hospital performs plasmapheresis for all patients in need of blood purification. The cost of donor plasma and blood substitutes is included in the price of the procedure.

Plasmapheresis is regarded as a universal efferent method that allows you to influence toxins of any nature, electrochemical charge, molecular weight. In recent years, plasma membrane filters have become widespread. They allow you to separate the liquid part of the blood from the formed elements. Plasmapheresis allows you to influence the structure of cell membranes of platelets and red blood cells. The total detoxification effect of plasmapheresis and its effect on blood fluidity are higher compared to other efferent methods.

Plasmapheresis is used as an independent method of extracorporeal blood purification or as part of detoxification measures, if the plasma obtained by plasmapheresis is exposed to sorbents, filtration, precipitation (interaction with an agent, as a result of which a precipitate forms). When carrying out plasma exchange, a certain volume of the liquid part of the blood is removed. Then at least 70% of the removed volume is replaced with fresh frozen donor plasma or a 5% albumin solution. This version of plasmapheresis is used to combat external intoxication syndrome. Plasmapheresis is effective for endotoxicosis, which develops due to the production of pathological products of a high-molecular nature, and polytoxicosis, which develops due to an excess of toxic substrates of various molecular weights.

Currently, doctors are increasingly using selective plasmapheresis methods. They are based on cryoheparin precipitation. Selective plasmapheresis techniques can increase the efficiency of the procedure and reduce the amount of required plasma replacement media. The cryoapheresis method is based on the property of the plasma protein fibronectin to form polymers in the presence of heparin in the cold and precipitate. Using this technique, from 30% to 50% of immunoglobulins M, A and G, fibrinogen, the C3 component of complement, and peroxide-modified lipoproteins are removed from the patient’s body, while maintaining up to 85-90%.

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Types of procedure

There are two types of plasmapheresis:

Therapeutic, the purpose of which is to remove various toxic substances from the body along with “contaminated” plasma;
Donor - plasma is taken from a healthy person - a donor, and is subsequently infused into a patient in need.

In addition, depending on the method used to obtain plasma, plasmapheresis can be:

Hardware;
Centrifuge;
Membrane;
Sedimentation;
Cascading.

Plasmapheresis is essentially similar to many other methods of cleansing the blood of toxic elements.

After blood is collected from the venous bed, it is sent through a special tube to the machine. Then, depending on the type of plasmapheresis, various procedure options are possible:

During centrifugal plasmapheresis, plasma is separated from formed elements in a special device rotating at high speed. Then the formed elements are returned back into the bloodstream, and the plasma is removed from the device and disposed of;
With membrane plasmapheresis, plasma is separated using a special filtration system. Thanks to the use of disposable filters, which are removed after use, the likelihood of contracting viral infections (HIV infection, hepatitis C) is reduced to zero;
The principle of cascade plasmapheresis is not similar to other techniques described above. During this process, the resulting plasma is additionally filtered. This method allows you to remove high-molecular compounds from the body. When a high degree of purification is achieved, the plasma is returned back.

Indications for use

The procedure is indicated for a variety of diseases and pathological processes that lead to the formation and accumulation of pathological elements in the blood. Plasmapheresis at the Yusupov Hospital is carried out if patients have the following diseases and conditions:

Sepsis – to reduce the number of bacteria in the blood;
Long-term compression syndrome - to remove formed toxic substances;
HIV infections;
Autoimmune pathologies – to remove aggressive autoantibodies;
Atherosclerosis;
Liver diseases accompanied by elevated levels of liver enzymes;
Poisoning (toxic substances, medications);
Severe alcohol intoxication, drug addiction.

Plasmapheresis is also prescribed to people suffering from:

Oncological diseases;
Damages to the heart muscle;
Hypercholesterolemia (high levels of “bad” cholesterol in the blood);
Complications after a heart attack;
Rheumatism;
Diseases of the organs of vision;
Kidney pathologies;
Myocarditis of viral etiology;
Pulmonary vascular diseases;
Bronchial asthma;
Alveolitis;
Pneumonia;
Crohn's disease;
Nonspecific ulcerative colitis;
Diabetes mellitus
Diseases of the reproductive system;
If there is a Rh conflict during pregnancy;
Acne;
Dermatological problems (allergic rashes, psoriasis, urticaria, etc.);
Neurological diseases.

The blood purification procedure is indicated for people who have problems with the skin (allergic rashes, psoriasis), joints, eyesight, and urinary system. Plasmapheresis sessions stabilize the condition of patients with multiple sclerosis, thromboembolism, alcoholism, and drug addiction. They are performed in the presence of Rh conflict during pregnancy.

The American Academy of Neurology has established the following indications for plasmapheresis in neurology:

Severe form of Guillain-Barre syndrome;
Chronic inflammatory demyelinating polyneuropathy;
Polyneuropathy with monoclonal gammopathy with a possible role of IGG/LGA;
Crisis or preparation for surgery of patients suffering from myasthenia gravis;
Multiple sclerosis.

Plasmapheresis is successfully used to treat about two hundred diseases. The procedure, combined with drug therapy, can significantly improve the condition of patients and eliminate existing symptoms of diseases. Membrane plasmapheresis at the Yusupov Hospital is successfully used to treat cancer. High results of the procedure are ensured by the latest equipment and extensive experience of doctors.

Expert opinion
Alexey Vasiliev
Head of the Department of Neurology, Candidate of Medical Sciences, neurologist of the highest category
“High-volume plasmapheresis is considered the gold standard treatment for a wide range of neurological diseases. It is performed for patients with severe, aggressive multiple sclerosis, acute disseminated encephalomyelitis, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy and many other diseases. This treatment method has a pronounced therapeutic effect, is safe and accessible to patients.
At the Department of Neurology of the Yusupov Hospital, plasmapheresis is performed with a volume of 2-2.5 liters per session. Such intensive use of plasmapheresis allows you to maximally cleanse the body of toxins and antibodies that destroy the myelin sheath of nerve fibers. After several sessions, patients note a decrease in the symptoms of the underlying disease and a general improvement in well-being.”

Medication methods

Blood purification drugs are divided into several groups:

statins are medications that cleanse the blood and lymph, lower cholesterol levels, and have virtually no side effects. This group includes simvastatin, lovastatin, pravastatin and others;
sequestrants - lipid-lowering tablets that bind liver and bile fatty acids, lower cholesterol, prevent the development of coronary heart disease and atherosclerosis (for example, cholisteramine);
fibrates reduce the secretion of fats and the formation of cholesterol. Long-term use is fraught with the formation of stones in the liver and gall bladder. This can include bezamidine, lipanor, gevilon, atromidine and others;
B vitamins and ascorbic acid.

Contraindications to plasmapheresis

Like any other procedure, plasmapheresis has some limitations: absolute and relative contraindications. The need for its use is determined by the attending physician after a comprehensive examination of the patient. Plasmapheresis is absolutely contraindicated in case of serious damage to vital organs (these include the brain, heart, lungs, kidneys and liver), as well as in case of massive bleeding. Due to the high risk of complications, including death, plasmapheresis is not performed if the patient has the following absolute contraindications:

Cardiovascular diseases (especially the right parts of the heart muscle);
Cerebrovascular accidents;
Arterial hypertension (excessively high blood pressure);
Anemia;
High blood clotting;
Blood too thick;
Acute and chronic liver dysfunction;
Drug addiction and neuropsychiatric disorders.

Blood purification is prescribed with caution in the following conditions:

Tendency to bleed;
Ulcerative lesions of the digestive tract;
Arrhythmias, low blood pressure;
Insufficient level of protein in the blood;
Infectious processes in the acute stage;
Menstruation (women).

Positive effects

Plasmapheresis allows you to cleanse the blood of harmful substances:

Metabolic products - uric acid, urea, creatinine;
Inflammatory mediators;
Hormones;
Antigens;
Antibodies;
High molecular weight lipids;
Toxins.

The procedure allows you to achieve significant physiological changes. By creating artificial hypovolemia, the body's protective properties are activated. Swelling decreases, the concentration of harmful substances in the blood decreases. In order for the results of the procedure to be as high as possible, patients at the Yusupov Hospital are prescribed a therapeutic course of plasmapheresis, which usually consists of three to four sessions.

Preparing the body

Blood is a liquid that absorbs all the waste products of our body. Now mentally conduct an experiment. There are two riverbeds: one covered with clean pebbles, and the second with garbage. Both flow with water from the same source. Which channel will deliver clean water to the sea, and which will deliver polluted water? It's not hard to guess.

Therefore, even before cleaning the “liquid” in our body (and this is the literal translation of the ancient Indo-European prototypes of the word “blood” in many languages), we should clean the “banks and bed” - that is, the body, namely the stomach and intestines, after all, most of the “impurity” comes through food .

Even people leading a healthy lifestyle, before one-day fasting, should limit themselves to light food in the second half of the previous day, and also not overload the stomach immediately the next day. As experienced healthy lifestyle instructors say: “you need to enter a hunger strike gently and exit it gently.”

As for those who are accustomed to not limiting themselves to anything in everyday life, they need to refrain for several days from :

nicotine (and any other drugs);
alcohol;
fatty, spicy, salty, fried;
sparkling water, any energy drinks;
sweets, flour, fast food and overeating in general.

It is known that the toxins of nicotine and alcohol enter directly into the blood and remain there for many hours (after a single drink of alcohol) and even days (with constant smoking). Toxins from food also remain in the body for a long time (it is intoxication that causes frequent headaches, malaise without illness, “withdrawal”).

If you do not abstain for several days and abruptly switch the body to cleansing, the concentration of highly toxic poisons in the blood will be very high, and in the absence of the usual nutrients, this will lead to unbearable headaches, dizziness, and surges in blood pressure. Everything can very easily end in hospitalization.

What diseases is it used to treat?

Plasmapheresis is an indispensable detoxification method for poisoning with alcohol, external and internal toxins, and poisons. The procedure is used to prevent stroke, heart attack and other cardiovascular diseases. A course of plasmapheresis helps to gradually cleanse blood vessels of cholesterol deposits, making them strong and elastic. Normal blood circulation in the body is restored, and the risk of cardiovascular diseases is reduced. Patients experience heart pain, blood pressure normalizes, memory and sleep quality improve.

By ensuring good blood supply to the body, plasmapheresis improves the functioning of the heart, blood vessels, and kidneys. The risk of developing diabetes complications is reduced. After the procedures, trophic ulcers heal quickly. Plasmapheresis can overcome insulin resistance.

The positive effect of plasmapheresis is observed in autoimmune diseases (bronchial asthma, allergies, rheumatoid arthritis, multiple sclerosis). These diseases arise as a result of disturbances in the functioning of the human immune system, when it begins to perceive its own tissues as foreign and fight them, producing special autoantibodies. During plasmapheresis sessions, they are removed from the body, like other harmful substances. A course of plasmapheresis helps to quickly cope with exacerbation of the pathological process, prolong the period of remission and prevent possible complications of the disease. Plasmapheresis also allows you to significantly reduce the dose, and sometimes even cancel it, of hormonal drugs.

Plasmapheresis allows you to quickly stabilize the patient’s condition and improve liver function in hepatitis B and C. The success of drug therapy for hepatitis directly depends on the amount of viral components in the body. The virus changes and deforms the cells of the body, disorients the immune system, which begins to produce antibodies to its own cells. Systemic diseases (diabetes mellitus, autoimmune thyroiditis) are added to hepatitis. In this case, hepatitis therapy becomes dangerous, because interferon drugs increase the body’s autoimmune aggression. The blood is purified from viral components, autoantibodies, circulating immune complexes and other harmful substances using plasmapheresis. Extracorporeal detoxification sessions allow you to provide the necessary treatment and prevent the development of autoimmune processes.

Chronic inflammatory processes of the reproductive organs occur in men and women. Their cause is viruses, fungi, bacteria. Diseases can occur either with clinical manifestations or hidden. Often chronic infections lead to infertility, sexual disorders, and cause disturbances in the development of the fetus in the womb. Antibacterial therapy is often not effective enough. Plasmapheresis cleanses the blood at a deep cellular level, allows you to influence the source of infection and cope with chronic inflammation. After plasmapheresis, the body's resistance to infection increases and reproductive function is restored.

Chronic fatigue syndrome is manifested by increased fatigue, which does not go away even after proper rest. Patients are depressed, they suffer from headaches, and their performance decreases. Pain in muscles and joints, irritability, disturbances in sleep quality appear, lymph nodes become enlarged, and body temperature rises for no reason. In this state, the body is not able to cope with infectious agents. Antiviral drugs, immunomodulators, antidepressants do not solve the problem. The use of plasmapheresis makes it possible to restore the body’s lost resistance to bacteria and viruses and to stop the manifestations of chronic fatigue syndrome.

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Tablets or plasmapheresis? The choice is yours!

These conditions have pushed plasmapheresis slightly towards exotic techniques that are too complex for outpatient clinics or small clinics. And the constant fuss of drug manufacturers and dealers around efferent methods (blood secretion and its external modification) as little tested (and this is for 100 years), as expensive and complex, as well as active work with doctors to promote drugs on the medical market, have noticeably weakened interest to plasmapheresis. Why, such a factor as a reliable, statistically proven by a number of early studies, reduction in the consumption of drugs in the treatment of serious diseases, like a red mantle, irritates the manufacturers of hormonal drugs. Why do they need such a competitor? Therefore, ambiguous works periodically appear in the medical press, hinting at the dubiousness of the plasmapheresis method in therapy. The goal is simple - to discourage practitioners from even the shadow of a thought about using plasmapheresis in the treatment of a particular disease where it is necessary to use corticosteroids, for example, atopic dermatitis, bronchial asthma, scleroderma, lupus. After all, it is obvious that a reduction by a third in the consumption of prednisolone by patients will primarily affect the income of pharmacists-manufacturers and sellers. And the fact that patients’ bones are destroyed, Cushing’s syndrome (obesity) and stomach ulcers develop cannot but rejoice - after all, the volume of drugs consumed is not decreasing, but increasing.

Examination before the procedure

To identify indications and contraindications for plasmapheresis and to exclude possible complications of the procedure, patients at the Yusupov Hospital undergo a comprehensive examination on the eve of the procedure:

Examination by a therapist, which includes measuring blood pressure and assessing other important indicators of the body’s functioning;
Clinical blood test to diagnose acute or chronic inflammatory process and other diseases;
Determination of blood glucose levels (allows you to identify diabetes mellitus, and in persons with a confirmed diagnosis - to control blood glucose levels);
Coagulogram (for the purpose of assessing the parameters of the blood coagulation system, identifying a tendency to increased bleeding or blood clots);
Blood test for the Wasserman reaction (allows you to detect syphilis);
Determination of antigens to HIV and hepatitis;
A biochemical blood test with determination of the level of protein fractions allows us to identify a low protein content in the blood, which is a relative contraindication to plasmapheresis sessions.

In order to evaluate the work of the heart, an electrocardiogram is recorded using modern devices. At his discretion, the doctor may prescribe other examination methods that confirm the need for plasmapheresis or exclude this method of extracorporeal detoxification for a particular patient.

Why is it so important to reduce blood viscosity?

The mechanism of development of this pathological process is quite simple. As blood viscosity increases, its movement through the vessels is disrupted.

Slow blood flow can lead to the development of atherosclerosis, varicose veins and hemorrhoids. In addition, too viscous blood can lead to the development of liver, kidney and heart failure. The most terrible and dangerous development of events may be pulmonary embolism, stroke and heart attack. These pathological conditions are caused by the formation of blood clots in vital vessels. Quite often, such conditions lead to the death of the patient, especially if assistance is not provided in the first hours. Often the cause of death is cardiac arrest or blockage of the pulmonary arteries.

what is important to consider about blood viscosity

Possible complications

Complications may develop if the medical staff performing the procedure does not properly comply with all instructions. Plasmapheresis may be accompanied by the following complications:

Formation of blood clots and hemolysis in the device. Thrombosis can be prevented by the use of adequate doses of heparin;
Allergic reactions to the materials of the plasmapheresis device. The ultra-modern equipment of the Yusupov Hospital eliminates these phenomena;
Phlebitis - a section of the vein that is punctured for blood sampling can become inflamed;
Embolism;
Bleeding – occurs with an overdose of drugs that reduce clotting rates. The likelihood of bleeding is increased in persons suffering from peptic ulcers of the digestive system;
Sepsis, HIV infection (human immunodeficiency virus). At the Yusupov Hospital, plasmapheresis is performed only with sterile disposable needles and instruments, due to which the likelihood of infection is reduced to zero; the clinic has a license to provide transfusiology.

Nowadays, plasmapheresis is the most effective auxiliary method used to treat most diseases. Contrary to popular belief, this procedure does not have a general strengthening and rejuvenating effect. The majority of patients who have undergone plasmapheresis at the Yusupov Hospital leave positive reviews about this procedure. Their well-being improves, their performance increases, and they feel a surge of strength.

The benefits of plasmapheresis are as follows:

strengthening the body's defenses;
reducing the level of “bad” cholesterol in the blood;
acceleration of metabolic processes;
improving cell oxygen saturation.

Before undergoing plasmapheresis at the Oncology Clinic of the Yusupov Hospital, patients are prescribed a comprehensive examination to identify diseases for which this procedure is contraindicated. Thanks to the ultra-modern equipment of the clinic, the research results obtained are of maximum accuracy. After plasmapheresis sessions performed at the Yusupov Hospital, complications do not develop.

Therapeutic effects

Guaranteed effect of the procedure:

reduction of pain syndrome;
stimulation of metabolic processes;
increasing the protective functions of the body;
relief of smooth muscle spasms;
improvement of blood composition;
activation of regeneration processes;
elimination of edema;
active supply of tissues with oxygen;
improvement of blood and lymph flow.

Advantages of performing the procedure at the Yusupov Hospital

Plasmapheresis at the Yusupov Hospital is carried out by experienced specialists who, during the procedure, monitor the appearance of any changes in the patients’ condition and, if necessary, make adjustments. To perform plasmapheresis, the Yusupov Hospital has the latest equipment that ensures the highest quality of its implementation. Patients are housed in comfortable, cozy, clean rooms, the equipment of which corresponds to the latest technology.

The experienced medical staff of the Yusupov Hospital provides round-the-clock professional care to patients. You can get up-to-date information about the nuances of preparing for the plasmapheresis procedure and its cost, and make an appointment with a specialist online or by calling the Yusupov Hospital. The contact center operates 24 hours a day, seven days a week, seven days a week.

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