Plasmapherese und immunadsorption

Background: Plasma exchange and immunoadsorption are two treatment modalities to clear patient plasma from pathogenic substances. In 2013 revised guidelines for approximately 80 diseases were published with different levels of evidence. Aim: This review focuses on the history and the present therapy of therapeutic plasma exchange (TPE) and immunoadsorption as part of the work of nephrologists. Insights into the pathophysiology and drug elimination are presented, new guidelines are explained and the application in intensive care units is discussed. Methods: The current guidelines of the American Society for Apheresis from 2013 are discussed, including literature of drug elimination during TPE and the use of plasmapheresis and immunoadsorbtion in the intensive care unit (ICU). Results: Plasma exchange is characterized by removal of patient plasma, accompanied by replacement with fresh frozen plasma, albumin or other solutions to maintain plasma volume and colloid osmotic pressure whereby the components of coagulation and immune response are unaffected. Immunoadsorption is an adsorption technology where patient plasma is perfused through specific columns to selectively remove antibodies or other substances from the plasma by adsorption which is then returned to the patient. The levels of evidence for a therapy show substantial differences in the amended guidelines from 2013 depending on the symptoms. In cases in which both methods are applicable, the final decision should be made depending on published data, local experience and planned duration of therapy. Adverse events due to the methods are seldom and differ between TPE and immunoadsorption. The influence of the methods on drug elimination is not easily predictable and needs to be given a great deal of consideration in individual cases. Discussion: Specialists from medical disciplines other than nephrology are not always familiar with the risks and potential adverse events of both methods. Nephrologists should be aware of these facts and support other colleagues performing these therapies if an indication for treatment is confirmed.