plasma exchange (PE)
is a commonly used in vitro blood purification technology in clinical practice. Its main mechanism is to lead the patient's blood out of the body, separate it into cell components and plasma through a plasma separator, discard abnormal plasma, and then the cell components and discarded plasma are equal to the replacement solution back to the patient's body to play a role in clearing the pathogenic factors [1].
Why can plasma replacement treatment effectively relieve symptoms?
Blood replacement can quickly remove pathogenic factors in the blood, including autoantibodies , immunoglobulin , immune complexes, inflammatory mediators, uremia toxins, toxins, excess low-density lipoprotein, etc. In addition, normal plasma and replacement fluid can be supplemented to restore cellular immune function, improve the phagocytosis function of reticular endothelial cells [2], and control the disease.
Single-weight plasma replacement
is the basic model of plasma replacement and is widely used in clinical practice.
The main steps include:
Double plasma replacement
Handle plasma replacement
Secondly separate the isolated plasma on the basis of single plasma replacement and remove the macromolecular pathogenic factors therein, and then re-inject the plasma protein containing albumin , such as albumin , and other molecular weight , and then re-inject the plasma protein with a smaller molecular weight into the body. Compared with single plasma replacement, the treatment of dual plasma replacement is more targeted, and can selectively remove pathogenic factors in the plasma and reduce the loss of albumin. At the same time, the secondary isolation of plasma can be returned to the patient's body, reducing the use of exogenous plasma, thereby reducing the risks of blood infection, allergies, etc., and is safer. [3].
Indications and contraindications for plasma replacement
Indications
914 Abel first proposed the concept of plasma removal. It was not until the 1960s that an intermittent plasma separator appeared, and a membrane plasma separation device appeared in the late 1970s. With the development and renewal of the equipment, there are currently more than 200 diseases treated with plasma replacement therapy, including rheumatism and immunity, kidneys, liver, pancreatic , metabolic diseases, neurological diseases and transplantation. Commonly treated diseases are found in the table below [4-6]:
013 The American Society for Plasma Exchange (ASFA) formulated the sixth edition of the plasma replacement guide [7], and based on evidence-based classification of the above diseases into different recommendation levels in order to guide the clinical practice. However, it should be pointed out that plasma replacement therapy is only more effective and rapid to remove pathogenic factors, creating a better treatment opportunity for subsequent clinical treatment, and cannot replace etiology treatment, so etiology treatment cannot be ignored. contraindications
plasma replacement has no absolute contraindications, and relative contraindications include:
In recent years, with the continuous development of plasma replacement surgery, it has become more and more widely used in clinical practice, playing an important role in the treatment of liver diseases, kidney diseases, hematological diseases and other diseases, and can improve patient prognosis. Today we have reviewed the classification of plasma replacement, indications and contraindications.
References
. Boada, M., López, O., Núñez, L., Szczepiorkowski, Z. M., Torres, M., Grifols, C., Páez, A. (2019). Plasma exchange for Alzheimer’s disease Management by Albumin Replacement (AMBAR) trial: Study design and progress. Alzheimer’s Dementia: Translational Research Clinical Interventions, 5, 61–69.. Guo Mengyuan. Research progress in clinical application of plasma replacement technology [J]. Medical Theory and Practice, 2015(14).. Gao Minhui, Qiao Yufeng. Development and clinical application of dual plasma replacement [J]. World's Latest Medical Information Abstracts, 2018, v.18(38):64-65+68.. Yao Xiaoying, Guan Yangtai. Application of plasma replacement in neuroimmune diseases [J]. Journal of Neurology and Neurorehabilitation, 2018, 14(03):117-125.. Zeng Junhong. Research progress in clinical application of plasma replacement technology [J]. Journal of Rational Clinical Drug Use, 2018,11(12):178-179.. Liu Xinyu, Wang Xiaohong, Li Bin, Li Yongqiang, Huang Min, Liu Aiqun, Zou Hequn. Application of plasma purification therapy in rheumatoid and immune diseases [J]. China Blood Purification, 2012,11(12):646-649.7. Schwartz J, Winters J L, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue[J]. Journal of clinical apheresis, 2013, 28(3): 145-284.
End
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