Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications

Abstract

Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. This review highlights the pathophysiologic basis, specific clinical indications, and treatment parameters for disorders that more commonly require management in the intensive care unit. The choice of plasma or cellular apheresis in these cases is guided by well-accepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.

Comparison of plasma exchange performances between Spectra Optia and COBE Spectra apheresis systems in repeated procedures considering variability and using specific statistical models

“…As treatments can be used in critically-ill patients [11] or during advanced kidney injury in association with haemodialysis [12], the tolerance had to be checked. To confirm the interest in SPO we had to verify that the occurrence of the side effects was not higher after SPO than after CSP.…”

Management of the critically ill child with the sepsis/hemophagocytic lymphohistiocytosis/macrophage activation syndrome overlap syndrome

“…The overall concept of PE is in these diseases, therefore, is to attenuate the overwhelming systemic overflow of pro-and anti-inflammatory mediators released at the early phase of disease and to restore a broad-based humoral homeostasis. PE was found as a successful therapy in MAS, Still's disease, catastrophic antiphospholipid syndrome and sepsis [84][85][86][87][88]. Demirkol et al [51] investigated the efficacy of PE treatment in hyperferritinemia associated acquired HLH/SIRS/MODS/ MAS patients.…”

Regional citrate anticoagulation—a safe and effective procedure in pediatric apheresis therapy

“…The indications for plasma therapy are varied, ranging from the treatment of autoimmune and rheumatologic diseases, hematologic disorders, and renal and neurologic diseases, drug removal, and support for inborn error metabolism, liver failure, and sepsis [1][2][3][4]. Commonly encountered problems in pediatric apheresis therapy are the management of anticoagulation, restricted possibilities for venous access, and disproportion of extracorporeal volume in comparison to the patient's blood volume [1].…”