For Gynecologists

Plasmapheresis in the combined treatment of genital infections.

Membrane plasmapheresis is included in the combined treatment of women with chronic colpitis, cervicitis, salpingo-oophoritis and endometritis caused by long-term persistence of genital bacterial and viral infection (chlamydia, genital herpes virus, cytomegalovirus, staphylococcus).

Membrane plasmapheresis is used for the purpose of:

  • Improving the general condition of the patient;
  • Reducing the severity of pain syndrome;
  • Reducing the frequency of exacerbations of the inflammatory process;
  • Elimination of toxic substances;
  • Deblocking of the natural detoxification systems (liver and kidneys);
  • Improving the rheological properties of the blood;
  • Microcirculation of the pelvic organs;
  • Reducing total peripheral vascular resistance, elimination of chronic DIC syndrome;
  • Elimination of the increased level of circulating immune complexes (CIC), correction of the content of immunocompetent cells;
  • Increasing sensitivity to endogenous and medicinal substances;
  • Increasing the rate of conception and of carrying a pregnancy to term.

Indications:

1. Ineffectiveness of conventional drug therapy (presence of pain syndrome, profuse leucorrhoea, rapid fatigue, malaise, irritability, sleep disturbance, brittleness of nails and hair, impaired reproductive function – infertility, miscarriage.

2. Frequent (more than 2 times a year) exacerbations of the inflammatory process of the genitals.

3. Hypercoagulation syndrome according to the data of the hemostasiogram.

4. Presence of signs of intoxication (according to the data of clinical and laboratory examination – intoxication index, level of middle molecules).

5. Decrease of immune status indicators according to the data of the immunogram, increased level of CIC and antisperm antibodies.

6. Intolerance to antibacterial and other medicinal agents.

7. Presence of concomitant inflammatory diseases of other localization (tonsillitis, bronchitis, cholecystitis, pyelonephritis, etc.).

Absolute contraindications:

1. Marked organic changes in the cardiovascular and nervous systems.

2. Anemia (Hb < 90 g/l)

3. Hypoproteinemia (total protein level <60 g/l).

4. Thrombocytopenia (platelets < 100 x 109/l).

5. Hypocoagulation.

Relative:

1. Absence of venous access.

2. Phlebitis of the peripheral veins in the stage of exacerbation.

3. Allergic reactions to anticoagulants, colloid and protein preparations.

4. Individual reaction to blood exfusion.

Procedure technique

Гінекологу — ілюстрація

The course of therapy consists of 3 PA procedures, with an interval of 1-2 days. Plasmapheresis is performed in an isovolemic mode, from 20% to 40% of the CPV is removed. Plasma replacement is performed in a ratio of 1:1,2 with 6% and 10% hydroxyethyl starch solutions (Infucol HES, Refortan, etc.) combined with saline. The total dose of heparin per procedure is 5 thousand units. It is advisable to begin the course of therapy in phase 1 of the menstrual cycle (day 6-7). The number of courses is determined individually.

Efficacy criteria:

1. Reduction of the pain factor in the small pelvis.

2. Improvement of the general and psycho-emotional state.

3. Normalization of menstrual and sexual function.

4. Absence of exacerbations and preservation of working capacity during the year.

5. Absence of signs of intoxication (according to the data of clinical and laboratory examination).

6, Achievement of clinical and laboratory objective remission of viral and bacterial infection.

7. Improvement of the function of the natural detoxification systems.

8. Reduction and removal from the bloodstream of the increased content of antigen – antibody immune complexes.

9, Onset of pregnancy and its carrying to term.

Plasmapheresis in the combined treatment of chronic recurrent salpingo-oophoritis

Membrane Plasmapheresis (MP) is used in the combined treatment of patients with chronic salpingo-oophoritis (CSO) who suffer from infertility. PA in the combined treatment of CSO is performed for the purpose of reducing the severity of pain syndrome, reducing the frequency of CSO exacerbations, improving the psycho-emotional status of the patient, elimination of toxic substances, deblocking of the natural detoxification systems; reducing blood viscosity, improving blood microcirculation of the pelvic organs, reducing total peripheral vascular resistance, elimination of chronic DIC syndrome; reducing the level of endotoxins (middle molecules) and circulating immune complexes (CIC); increasing sensitivity to endogenous and medicinal substances; increasing the rate of pregnancy onset

Indications:

1. Ineffectiveness of conventional drug therapy (presence of pain syndrome, profuse leucorrhoea, rapid fatigue, malaise, irritability, sleep disturbance, brittleness of nails and hair, impaired reproductive function).

2. Frequent (more than 2 times a year) exacerbations of the inflammatory process of the uterine appendages.

3. Presence of signs of intoxication (according to the data of clinical and laboratory examination).

4. Intolerance to antibacterial and other medicinal agents,

5. Combination of chronic inflammatory diseases of the genitals with viral infection.

6. Presence of concomitant inflammatory diseases of other localization.

Absolute contraindications:

1. Marked organic changes in the cardiovascular system.

2. Anemia (Hb below 90 g/l).

3. Febrile state.

4. Hypocoagulation;

Relative:

1. Absence of venous access.

2. Phlebitis of the peripheral veins in the stage of exacerbation.

3. Allergic reactions to anticoagulants, colloid and protein preparations.

Procedure technique:

The course of treatment includes 2-4 PA sessions with removal of 30-40% of the CPV per session. Plasma replacement is performed with colloid and crystalloid solutions (6% or 10% hydroxyethyl starch), combined with saline in a ratio to the infusion volume of 1: 1,2, Heparinization is performed at a rate of 50-100 units per 1 kg of weight, the interval between sessions is 2-4 days. The circulating blood volume is determined taking into account body weight, height and the type of constitution according to the Moore method.

Efficacy criteria:

1. Improvement of the general condition.

2. Improvement of clinical and laboratory indicators.

3. Reduction of the frequency of exacerbations, reduction of pain syndrome.

4. Relief of chronic DIC syndrome.

5. Restoration of the reproductive function of women.