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Selective Hemapheresis, an Effective New Approach in the Therapeutic Management
of Disorders Associated With Rheological Impairment: Mode of Action and Possible
Clinical Indications
Artificial Organs
2002;26:117-123.
Peter Schuff-Werner, Birgit Holdt
This review highlights the use of selective apheresis procedures with respect to
their ability to alter the rheological properties of blood to treat various diseases.
These are important concepts, especially in the case of atherosclerosis, where the
lipid-laden vessel walls are unresponsive to vasodilatatory stimuli, or in the case
of individuals with familial hypercholesterolemia (FH). Changes in blood or plasma
viscosity can improve blood flow and supply of oxygen in these situations. The improvement
of clinical symptoms, such as angina pectoris pains, by modifying blood's rheological
properties and increasing blood flow has been shown to be effective.
The use of plasmapheresis with subsequent substitution with fresh frozen plasma
or by human-albumin-salt solution is an effective approach to altering the rheological
properties of blood. However, it suffers from several disadvantages:
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Concern regarding the safety of the plasma substitutes (eg, viral infection) |
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Potential for immunization due to the presence of foreign proteins |
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Frequency of application may be limited due to loss of coagulation factors, immunoglobulins,
and other necessary plasma proteins |
Thus, the development of apheresis procedures (immunoadsorption, anionic adsorption
via dextran sulfate or heparin, the heparin-induced method, differential filtration)
has allowed for novel approaches to alter the rheological properties of blood. As
an example, differential filtration and anion-induced extracorporeal plasma protein
precipitation exert the most dramatic effects on plasma viscosity and erythrocyte
aggregation. In a series of experiments, the authors demonstrate that its effect
on viscosity and erythrocyte aggregation is more pronounced, presumably because
of its less selective nature, resulting in the removal of additional plasma proteins.
These findings are confirmed by the observation that plasma viscosity and erythrocyte
aggregability is more effective in FH patients undergoing apheresis by differential
filtration (18%), the heparin-induced method (13%), and dextran sulfate adsorption
(12%), rather than immunoadsorption (8%).
Details on the use of the various procedures for specific diseases (eg, macroglobulinemia,
hyperlipoproteinemia, hypertriglyceridemia, pancreatitis, and coronary heart disease)
indicate that improving the blood's rheological properties leads to significantly
better patient outcome.
Click for full abstract.
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