Therapeutic plasmapheresis in rheological disorders: Indications and limitations

Abstract

Elevated levels of pathological (as in myelomas) as well as physiological (fibrinogen, lipoproteins) plasma protein concentrations can increase blood or plasma viscosities above the normal levels. This in turn leads to a decrease in tissue perfusion and in turn to typical neurological, cardiac, ocular, or peripheral-vascular sequela. Therapeutic plasmapheresis can very easily and effectively reduce the excessive protein concentrations and thus reverse the course of hyper viscosity. The treatment is thus indicated in such syndromes as Waldenström’s disease, multiple myeloma, and hyperlipidemia. However, plasmapheresis does not influence the underlying disease process. Therefore, the extracorporeal removal of proteins must be combined with appropriate pharmacological therapy, especially to avoid an overshoot stimulation of protein synthesis. - The possible future relevance of cascade filtration and immunoadsorption to plasma exchange is discussed.