Double filtration plasmapheresis: Review of current clinical applications

Abstract

Double filtration plasmapheresis (DFPP) is a semi‐selective blood purification modality derived from the plasma exchange (PE) modality. In the DFPP treatment, two types of filters with different pore sizes are used: a plasma separator and a plasma component separator. Blood is separated into plasma and blood cells using a plasma separator. The separated plasma is fractionated into large and small molecular weight components by a plasma component separator. Large molecular weight components, including pathogenic substances, are discarded. Small molecular weight components, including valuable substances such as albumin, are returned to the patient. The advantage of DFPP is that the volume of replacement fluid can be significantly reduced compared to PE. By selecting the optimal pore size model for the plasma component separator, DFPP can be applied to various disorders. The clinical applications of DFPP are reviewed based on recent articles on metabolic disorders, organ transplants, rheumatic disorders, neurological disorders, and dermatologic disorders.

Comparison of Therapeutic Plasma Exchange and Double Filtration Plasmapheresis: Five Year Experience of Nephrology Unit

“…Complement system activation and hemolysis are more commonly seen in double cascade compared with single filtration and this was an important consideration for vulnerable diseases 10 in our center but there were no significantly higher complications rates in the DFPP group compared with the single filtration technique. This method was more commonly used in autoimmune indications within neurological diseases 11,12 and remission rates were higher in this group. Besides neurological indications, the total number of 55 patients underwent 391 sessions of DFPP in our center and this number is higher than the previous reports 12 .…”

Prospects of plasmapheresis for patients with severe COVID-19

“…), in liver transplantation (desensitization), for treatment of myasthenia, thrombotic microangiopathy, thrombocytopenic purpura, Wilson disease, antiphospholipid syndrome, drug overdose, intoxications, systemic lupus erythematosus and various other diseases. 15-19 …”

“…), in liver transplantation (desensitization), for treatment of myasthenia, thrombotic microangiopathy, thrombocytopenic purpura, Wilson disease, antiphospholipid syndrome, drug overdose, intoxications, systemic lupus erythematosus and various other diseases. [15][16][17][18][19] In accordance with the classification of methods of extracorporeal haemocorrection (Sokolov AA, 2017) 20 the following methods relate to the effect on blood plasma:  membrane technology (plasma filtration, selective plasma filtration or selective plasma exchange, cascade plasma filtration, plasmа diafiltration)  centrifuge technology (plasmapheresis)  sorption technology (plasmosorption) and others. 20 In terms of efficiency and safety in regard to severe and critical patients, the procedure of selective and cascade plasma filtration has proved to be the most effective and safe of all.…”

How to improve clotting factors depletion in double‐filtration plasmapheresis

“…Usually, the first filter separates the blood cells from the plasma and the second filter allows the plasma to be processed by removing all substances whose molecular weight is greater than the diameter of the pores of the filter. The treated plasma is then returned to the patient 1 …”

“…DFPP is used for the treatment of various pathologies, depending on the target substance to be eliminated (immunoglobulins, LDL‐cholesterol or fibrinogen and clotting factors in order to improve blood rheology and tissue perfusion) 1‐10 …”