Rolf Bambauer, Reinhard Latza, M. Rigdon Lentz

Therapeutic Plasma Exchange and Selective Plasma Separation Methods
Fundamental Technologies, Pathology and Clinical Results

Third Edition

1. Introduction

1.1 Historical Highlights
1.1.1 Bloodletting
1.1.2 Plasmapheresis

1.2 Definitions

2. Methods

2.1 Membrane Plasmapheresis
2.1.1 Single-Needle Plasmapheresis (SN-TPE)
2.1.2 Other Devices for Plasmapheresis Devices for Membrane Plasmapheresis Devices for Centrifugal Apheresis Techniques
2.1.3 Recirculation Phenomena Recirculation in Single-Needle Technique Investigations of Recirculation in Single-Needle Technique
2.1.4. Comparison of Single-Needle and Double-Needle Technique

2.2 Membrane Technology
2.2.1 Basic Principles of Filtration
2.2.2 Physical Foundations and Membrane Separation Processes
2.2.3 Membrane Structure
2.2.4 Sieving Behaviour for Macromolecular Substances Using Various Membranes
2.2.5 Application of Polypropylene and Cellulose Diacetate Membranes: Side Effects and Technical Problems
2.2.6 Clinical Tests of a Polycarbonate Membrane Separator
2.2.7 Biocompatibility Membranes Adsorption Systems Microparticle Release from Adsorber Used for LDL-Apheresis Interaction Between Extracorporeal Surfaces and Blood Methods of Manufacturing Compatible Membranes

2.3 Material Kinetics
2.3.1 Flow Behaviour in Hollow Fibers
2.3.2 The Kinetics of TPE One Compartment Model Material Kinetics with the Single-Needle Method Results with the One Compartment Model
2.3.3 Elimination of an Artificial Immune Complex by TPE
2.3.4 Elimination of Coagulation Factors by TPE
2.3.5 Elimination of various Hormones by TPE
2.3.6 Elimination of various Immunoglobulins by TPE

2.4 Methods of TPE
2.4.1 Blood Access Catheter and Material Surface-Treatment Technologies for Catheters
2.4.2 Exchange Volumes and Frequencies of TPE
2.4.3 Immunoadsorption, LDL-Apheresis
2.4.4 Substitution Possibilities
2.4.5 Anticoagulation in TPE
2.4.6 Additional Medication Therapy in TPE

2.5 Selective Separation Methods
2.5.1 Historical Overview
2.5.2 Equipment for Selective Separation Techniques
2.5.3 Cascade Filtration Technical Aspects of Cascade Filtration Kinetics of Cascade Filtration Results of Cascade Filtration and Indications
2.5.4 Cryofiltration
2.5.5 Thermofiltration
2.5.6 Unselective Adsorption Active Charcoal Ion Exchange Resins and Polymeric Adsorbents Plasmaperfusion
2.5.7 Selective Adsorption Specific Adsorption Protein A Immunoadsorption Immunosorba® System Prosorba® System Anti-IgG Immunoadsorption Fibrinogen Adsorption LDL-Apherese Imunoadsorption Heparin-induced LDL-precipitation (HELP system) LDL-Adsorption with Dextransulfate LDL Hemoperfusion System Lipoprotein (a)- Apheresis Different Adsorbents Electropheretic Separation Processes Selective Plasma Separation Combined Techniques BioLogic-DTPP System Molecular Adsorbent Recycling System (MARS) Enzyme Adsobents (Bioreactor) Tryptophan Side Chain Oxidase (TSO) Immunopheresis of Soluble Tumor Necrosis Faktor Inhibitors in Cancer

3. Efficacy and Indications of Therapeutic Apheresis (TA)

3.1 Pathophysiology and Clinical Aspects of Immunological and Non-Immunological Diseases
3.1.1 Autoimmune Diseases Lysis Inflammatory Tissue Reaction Receptor Enzyme Blocade
3.1.2 Immunocomplex Diseases
3.1.3 Non-Immunological Diseases

3.2 Functioning Mechanism in Therapeutic Apheresis
3.2.1 Functioning Mechanism in Selective Separation Methods

3.3 Complications and Side Effects

3.4 Indications for TA

4. Clinical Results

4.1 Renal Diseases
4.1.1 Rapidly Progressive Glomerulonephritis (RPGN) Basic Pathophysiological Aspects Antibasement Membrane Antibody Glomerulonephritis (Goodpasture Syndrome, ABM-Ab-GN) Immune Complex Nephritis (ICN) RPGN with or without Glomerular Deposition (ANCA ab) Pauci – Immune RPGN Therapy Recommendations for RPGN
4.1.2 Glomerulonephritis with Nephrotic Syndrome
4.1.3 Hemolytic-Uremic Syndrome (HUS) Basic Pathophysiologic Aspects Therapeutic Interventions in HUS
4.1.4 Myoglobulinemic Renal Failure
4.1.5 Dialysis Encephalopathy
4.1.6 Kidney Transplant Rejection
4.1.7 Acute Renal Failure Causes of Acute Renal Failure Basic Pathophysiologic Aspects of ARF

4.2 Neurological Diseases
4.2.1 Guillain-Barre´syndrome
4.2.2 Myasthenia gravis
4.2.3 Multiple Sclerosis
4.2.4 Other Neurological Diseases

4.3 Hematological Diseases
4.3.1 Rhesus Incompatibility
4.3.2 Anemia Hemolytic Anemia Autoimmune Hemolytic Anemia Aplastic Anemia
4.3.3 Thrombocytopenia Idiopathic Thrombocytopenic Purpura (ITP) Thrombotic Thrombocytopenic Purpura (TTP)
4.3.4 Disseminated Intravascular Coagulation (DIC)
4.3.5 Coagulopathy Hemophilia A Acquired Factor VIII Antibodies in Non-Hemophiliac Patients
4.3.6 Hyperviscosity Syndrome Multiple Myeloma and Plasmocytoma Morbus Waldenström

4.4 Gastroenterologic Diseases
4.4.1 Liver Failure, Akute Liver Failure (ALF) Basic Pathophysiological Aspects Possible Therapies in Acute Liver Failure Therapeutic Apheresis in Chronic Liver Disease Other Temporary Liver Support Systems
4.4.2 Acute Pancreatitis
4.4.3 Other Gastroenterological Diseases

4.5 Endocrinological and Metabolic Diseases
4.5.1 Thyroid Storm Basic Pathophysiological Aspects Possible Therapies
4.5.2 Endocrine Ophthalmopathy
4.5.3 Type-I-Diabetes mellitus Basic Pathological Aspects Possible Therapeutic Measures
4.5.4 Hyperlipoproteinemia Basic Pathophysiological Aspects Possible Therapeutic Measurements Cascade Filtration Immunoadsorption Heparin-induced Cholesterol Precipitation (HELP) Dextran Sulfate Low-Density Lipoprotein (Liposorber) Low-density Lipoprotein Hemoperfusion (DALI) Conclusion

4.6 Respiratory Diseases
4.6.1 Asthma Bronchiale
4.6.2 Churg-Strauss-Syndrome
4.6.3 Wegener´s Granulomatosus (WG)

4.7 Dermatological Diseases
4.7.1 Pemphigus vulgaris Bullous Pemphigoid D-Penicillinamine-induced Pemphigus
4.7.2 Other Forms of Dermatosis

4.8 Autoimmune Diseases
4.8.1 Basic Pathophysiological Aspects
4.8.2 Systemic Lupus erythematosus (SLE) Basic Pathophysiological Aspects Possible Therapeutic Measures
4.8.3 Rheumatoid Arthritis
4.8.4 Inflammatory Eye Diseases

4.9 Oncological Diseases
4.9.1 Basic Pathophysiological Aspects and Chemotherapy Resistance
4.9.2 Possible Therapies
4.9.3 Conclusion

4.10 Infections (Septicemia)
4.10.1 Basic Pathophysiological Aspects
4.10.2 Various Infectious Diseases
4.10.3 Malaria Tropica

4.11 Exogenous Intoxications
4.11.1 Basic Pathophysiological Aspects
4.11.2 Possible Therapies
4.11.3 Conclusion

4.12 Miscellany

4.13 TPE in Children

5. Appraisement and Perspectives

5.1 Critical Evaluation of TPE
5.2 Future Perspectives

6. Appendix

6.1 References
6.2 Index

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