For Cardiologists
Membrane plasmapheresis in Zaporizhzhia is used in the combined therapy of patients with familial hypercholesterolemia, homozygous and heterozygous (refractory to lipid-lowering drug therapy).
Plasmapheresis is performed in cases where, for one reason or another, it is not possible to arrange selective apheresis of low-density lipoproteins.
Indications:
1. Hypercholesterolemia.
2. High level of low-density lipoprotein cholesterol (LDL-C).
3. High level of lipoprotein (a).
Procedure technique:
It is recommended to carry it out throughout life once a month against the background of ongoing pharmacological statin therapy. Given this frequency, the procedure is preferably performed by the method of membrane plasmapheresis (filtration of plasma through a plasma filter). Access to the bloodstream is obtained by puncture of the cubital veins. 0.5 of the circulating plasma volume (1-1,5 litres) is replaced. Crystalloid and colloid solutions in a ratio of 1:2 are used as replacement fluids (among the crystalloids, Ringer's solution should be considered optimal; among the colloids - 5% albumin or rheopolyglucin solution). Unfractionated heparin is used as an anticoagulant, at a rate of 50 ME in 1 ml of 0,9% sodium chloride solution, which is fed into the blood line system at a rate of 1,5-2,0 ml/min. Once every 3 months the state of the immunoglobulins, Hb, Ht should be monitored. In some patients a decrease in these parameters is possible and their correction may be required without interrupting regular PP.
Efficacy criteria:
1. Reduction of the LDL cholesterol concentration by 30-40% from the baseline level.
2. Improvement of microcirculation.
Plasmapheresis in patients with arterial hypertension
Indications:
1. Hypertension (BP > 140/90 mm Hg).
2. Refractoriness to antihypertensive drugs.
3. Blood hyperviscosity.
4. Hypercoagulation.
5. Hypercholesterolemia.
6. Elevated level of pressor agents (catecholamines, aldosterone, angiotensin I).
Procedure technique:
The course of PP consists of 3-5 procedures with an interval of 3-5 days. The preferred method is membrane plasmapheresis (MP), by filtration of plasma through a plasma filter. Access to the bloodstream is obtained by puncture of the cubital veins. 0,5 of the circulating plasma volume (1-1,5 litres) is removed (replaced). Crystalloid and colloid solutions in a ratio of 1:2 are used as replacement fluids (among the crystalloids, Ringer's solution should be considered optimal; among the colloids - 5% albumin or rheopolyglucin solution). Unfractionated heparin is used as an anticoagulant, at a rate of 50 ME in 1 ml of 0,9% sodium chloride solution, which is fed into the line system of the machine at a rate of 1,5-2,0 ml/min. In some patients with an insufficient antihypertensive effect or a recurrence of refractoriness, the course of PP is repeated 6-9 months after the first course.
Efficacy criteria:
1. Reduction of systolic and diastolic blood pressure by 10-15%.
2. Restoration of sensitivity to drug therapy (achievement of target BP levels < 140/90 mm Hg).
