The selective therapeutic apheresis procedures

Abstract

Selective apheresis procedures have been developed to target specific molecules, antibodies, or cellular elements in a variety of diseases. The advantage of the selective apheresis procedures over conventional therapeutic plasmapheresis is preservation of other essential plasma components such as albumin, immunoglobulins, and clotting factors. These procedures are more commonly employed in Europe and Japan, and few are available in the USA. Apheresis procedures discussed in this review include the various technologies available for low-density lipoprotein (LDL) apheresis, double filtration plasmapheresis (DFPP), cryofiltration, immunoadsorption procedures, adsorption resins that process plasma, extracorporeal photopheresis, and leukocyte apheresis.

Double filtration plasmapheresis in the treatment of pancreatitis due to severe hypertriglyceridemia

“…Plasmapheresis was initiated during the first 12 to 48 hours, together with ''nothing per mouth'' (NPO) diet and drug therapy. The mean TG level before plasmapheresis was 3136 mg/dL (35.44 mmol/L; range, 1306-6693 mg/dL, 14.76-75.63 mmol/L), and the mean APACHE II level before the first session was 6 (range, [3][4][5][6][7][8]. All patients made a full recovery, with a significant improvement in TG levels after plasmapheresis.…”

“…3 Six different options of extracorporeal lipoprotein apheresis are available worldwide, and they all seem to be similar in terms of effectiveness and safety. 4 Double filtration plasmapheresis (DFPP) is a semiselective method based on a double filter system: the first filter is the standard plasmapheresis filter that separates plasma from blood cells; the second filter does not allow passage of proteins with a diameter .15 nm, including lipidbinding proteins. Thus, smaller proteins can be returned to the patient's bloodstream together with blood cells previously separated from plasma.…”

Patient Selection and Timing of Continuous Renal Replacement Therapy

“…During TPE, a volume of plasma that is 1-1.5 times the estimated circulating plasma volume is removed and replaced with albumin or clotting products. Newer technologies are available for low-density lipoprotein apheresis, double filtration plasmapheresis, cryofiltration, immunoadsorption procedures, adsorption techniques, extracorporeal photopheresis and leukocyte apheresis [66] . The advantage of the selective apheresis procedures over conventional TPE is preservation of other essential plasma components such as albumin, immunoglobulins and clotting factors.…”

Lomitapide: a novel drug for homozygous familial hypercholesterolemia

“…Although the majority of patients with hyperlipidemia can be sufficiently treated with dietary modification and drug therapy, LDL apheresis is indicated as first line treatment and approved by the FDA for patients with HoFH, and to date, has been considered to be the only therapeutic option available to improve significantly the life expectancy of HoFH patients [14,15].…”

“…The two approved methods by the FDA are the LiposorberVR system and the heparin-induced extracorporeal LDL-C precipitation system [14].…”