MEMBRANE TERAPEUTIC PLASMAPHERESIS

Tens of thousands of unnecessary and even harmful substances enter the human
body with food, water, and air on a constant basis. Fighting them, the system
responsible for protection and homeostasis maintenance (organs of detoxification,
immunity, elimination) becomes weaker and weaker. Beside direct toxic influence,
these substances are also capable of causing grave metabolic disorders. A vicious
circle is formed, which the body itself cannot break, even aided by medicines. As a
result, a whole range of chronic and virtually incurable conditions develop. The
very fact that they develop testifies to the absence of natural powers to fight illness.
Environmental influences also precipitate allergic diseases, such as
neurodermitis, eczema, rhinitis, conjunctivitis, and the most perilous of them
asthma.
A large group is constituted of autoimmune diseases where some mislead
reactions in the body because the production of antibodies that, instead of
counteracting microbes and other foreign agents, start to destroy the bodys own
organs and tissues. This is the way chronic rheumatic disorders of the joints,
vessels, and skin develop. Such diseases as psoriasis or neurodermitis are classified
as skin disorders only due to the localization of their symptoms; in reality, all of
them arise as a result of homeostatic disturbances. Rheumatism and
glomerulonephritis stem from the same roots.
Such disturbances of homeostasis, including autoimmune processes, underlie
one of the most widespread atherosclerosis-related pools of diseases: essential
hypertension, coronary artery disease, ischemia of the brain or lower extremities.
Following a viral hepatitis, in particular or types, autoimmune chronic
hepatitis develops inevitably in 10 - 15 relatively symptom-free years; it further
progresses to irreversible hepatic cirrhosis and even primary liver cancer.

Diabetes mellitus does not present a serious danger at first sight, because insulin
or tableted rugs can maintain acceptable glucose levels. However, even this kind of
treatment does not prevent secondary metabolic disorders predictably leading to
vascular disturbances that are to blame for irreversible vision loss, deteriorated
vascular patency in the lower extremities, heart, and brain, resulting in a much
shorter life expectancy.
 Pronounced endotoxicosis characteristic of the course of pregnancy holds the
potential for a whole range of serious complications, the fetus being endangered
the most. Toxic products of these easily permeate the placental barrier and cause
the development of malformations, hamper the development of the liver, kidneys,
brain, and immune system. No less a danger for the fetus are the so-called latent
genital infections (chlamydiosis, mycoplasmosis, herpes, and cytomegalovirus
infection). They do not affect general health in other life periods, but in pregnancy,
they can be extremely harmful to fetal development, including the possibility of
intrauterine death.
Still, if the baby is born alive, he or she can face serious problems from their
very first minutes of life. The functional immaturity of many critically important
organs requires protracted and intensive treatment, which may not always be safe.
For instance, prolonged artificial pulmonary ventilation causes irreversible changes
in the lungs, and severe bronchopulmonary dysplasia is formed with time. An
immune defense system that has not been shaped enough in the intrauterine period
will falter in the newborns later life, too. Such babies are vulnerable to microbes,
viruses, and xenobiotics entering the body from the environment. The frequency
and duration of respiratory and some other diseases are increased. Allergic diseases
will strike at a more frequent rate.
For most of the described diseases related to the bodys impaired homeostasis
and causing grave chronic illnesses, conventional treatment methods are useless.
The drugs administered will only alleviate disease symptoms (bronchodilatation
for spasmodic bronchi, control of elevated arterial blood pressure, forced fluid
elimination in fluid retention etc.). Hormones mitigate the tissue reactions to
harmful substances that will be left where they are. Cytostatics will retard the
reproduction of autoantibodies. But all of this implies the high cost of a whole
range of adverse effects.
For these cases, a fundamentally new way of treatment is necessary efferent
therapy, i. e. straightforward elimination of toxic substances from the body. The
most efficient type of this treatment is PLASMAPHERESIS where molecules of
toxic substances are eliminated together with plasma, the liquid component of
blood. A treatment course usually consists of 4 5 subsequent procedures carried
out on alternate days, i. e. it takes up about two weeks.
Timely administration of efferent therapy and immunocorrection allows
prevention of disease aggravation. In particular, it makes sense at the very early
stages of disease. To a certain extent, these procedures can even be indicated for
people who, due either to past illnesses or to unfavorable working or
environmental conditions, have, with advancing age, accumulated pollutants in
their body that will sooner or later manifest themselves. These pollutants have
also a lot to do with premature ageing, since the mean duration of human life is
half that biologically possible. Homeostasis sanitation procedures are also
indicated after severe acute diseases.
The biologically determined duration of human life should beyond doubt be at
least110 years; some data suggest it should be 150 years. In reality though, the
mean duration of human life does not reach even the middle of this span. Whether
there has ever been that golden age of humankind when, as told by the Biblical
sources, people did reach that age it is hard to tell. The 80-year mark is not
reached by 65% of people, 90% do not reach 90 years, and only a few live beyond
their centenary. Even if human beings avoid illness and injury in their whole life,
they still inevitably die because of old age. But why, in some cases, this old
age takes 60-year-olds, while in other cases, it spares 90-year-olds? What is the
basis of ageing?
Many authors addressing these questions only point at life-long contamination
of the body, its self-intoxication as it were. But what are the mechanisms of the
subsequent disorders? What does the immune system do our principal guardian
of Health that is closely linked to the quality of life?
Indeed, ageing is accompanied by certain changes in the immune system among
others. They affect all of its components: stem cells, - and B-lymphocytes,
macrophages. Since early childhood, the thymic clock starts to gradually slow
down, which is observed as the lower proliferative activity of -cells; their
worsening effector and helper functions make one susceptible to infections and
malignancies (their rates are known to be age-related). An old person is indeed
increasingly vulnerable to infections, which become to be among the principal
direct causes of death. Respiratory infections and pyelonephritis are particularly
frequent. With advancing age, higher rates are seen also for a number of other
diseases, such as cardiovascular pathology, tumours, diabetes, and dementia. These
changes taking place in the body are often called age-related or normal for this
age.
Immunodeficiency implies a less strict control of abnormal mitoses, cell
divisions and formation of tumour cells. They occur in the body on a constant basis
and quite frequently at that; however, possessing a foreign antigenic structure, they
immediately are spotted by the immune guardians and exterminated on the spot.
If these guardians miss them the moment they appear and fail to exterminate
them on time, their antigenic structure is recognized as own not before long, and,
according to fundamental biological principles, the production of these antibodies
is blocked. The outcome of this body-tumour fighting becomes predetermined.
The consequences of an immunodeficiency are clearly demonstrated by the
specific viral syndrome of acquired immunodeficiency, AIDS. Pt suffering from
AIDS die because of either infections or malignant tumors. And the age-related
immunodeficiency differs from this analogue, AIDS, only in the scale of immunity
disorders, while the underlying principles are the same.
A slowing down production rate of bone marrow B-lymphocytes also
compromises the production of antibodies designed to fight virobacterial
infections. With age, even blood group-defining antibodies become weaker [ and
b].
Function of the immune system depends upon the versatility of lymphocytic
antigen receptors. Advancing age means that the universally poorer lymphocyte
generation properties of the thymus and bone marrow combine with antigenic
stimulation of their clone expansion. As a result, monoclonal immunoglobulins
appear, and the target of their reactivity shifts from external (foreign) antigens to
autoantigens. A clear correlation has been demonstrated between the decreased
depressor function of the thymus and age and the development of autoimmune
disorders.
Even more dangerous is the waning suppressor function of T-cells, which is
accompanied by the emergence of forbidden (for a normal state) lymphoid cell
clones that react to the bodys own antigens. The result is various types of
autoimmune disease. Over half of the elderly possess various autoantibodies,
though in moderate concentrations. Therefore rheumatoid factor causes less
pronounced polyarthritic symptoms as compared to genuine rheumatoid arthritis.
On the other hand, the majority of the elderly suffer from joint pain ascribing it
simply to salt deposition in the joints.
Antinuclear antibodies are a common finding. Anti-thyroglobulin antibodies are
often observed; they cause autoimmune thyroiditis with decreased thyroid
function. At the same time, thyroid hormones are crucial for the activity of the
immune system, and hypothyroidism further aggravates immunodeficiency in
elderly people. It is worthy of note that autoantibodies against three principal
thyroid antigens - thyroglobulin, thyroid peroxidase, and thyrostimulating hormone
are normally seen in 10.6 14.9% of healthy individuals aged 18 - 24 years; but
by the age 55 - 4 years, this rate goes as high as 24.2 30.3%. Even virtually
healthy donors have been shown to possess anticardiolipin antibodies (frequency
rate, 27%), anti-DNA antibodies (17%), antibodies to thyroglobulin and
microsomal antibodies (11% and 7%, respectively). The frequency rates of these
antibodies in healthy donors were shown to be on the increase in the period from
1992 to 1995.
Even senile dementia is a consequence of the production of autoantibodies to
central nervous system elements. In Alzheimers disease patients, gene mutations
may cause the formation of two types of autoantibodies, presenilin-1 and
presenilin-2. They are found in immunochemical assays and closely linked to nerve
fibers on post-mortem brain examination in these patients. DNA and RNA
mutations lead to the production of protein molecules that differ from normal ones
and further intensify metabolic abnormalities. For example, Alzheimers disease is
characterized by a cascade of consecutively developing disorders that lead to
amyloid plaque deposition on the vascular wall, infiltration and apoptosis of
microglial cells, and, finally, progressive loss of neurons.

Autoimmune processes are also a culprit of parkinsonism symptoms; they, too,

are not as pronounced as in Parkinsons disease proper. Reactions of autoimmunity
underlie the development of demyelinization, the cause of disseminated sclerosis
(multiple sclerosis type) and muscular dystrophy (myasthenia type). The elderly
often display symptoms of paraproteinemia, accumulation of monoclonal M-
components of immunoglobulins, which mimics multiple myeloma in this case.
Suggestive of genuinic amyloidosis are intracellular amyloid deposits, including
the formation of so-called senile plaques. They are thought to be a characteristic
sign of ageing in 60% of elderly people. Another common finding in older age is
amyloid deposition in the myocardium.
The state of the hepatic parenchyma in elderly people has been drawing special
attention in recent years. The livers size, blood flow intensity, and hepatic
perfusion go down by 30 - 40% between the third and fourth decades of life. The
hepatitis C virus incidence rate also grows: from 10% in individuals under 35 years
of age to 42% in those over 60 years; no connection was revealed with such risk
factors as intravenous drug abuse, tattooing, acupuncture, and surgery. Many
elderly people had no symptoms of liver disease even 20 years after HCV infection
had been diagnosed, but such symptoms were common enough on biopsy. Until
present, the connection between ageing and autoimmune liver disease has been
discarded. Still, the prognosis in chronic hepatitis and cirrhosis gets worse and
worse with advancing age. While the mortality rate in individuals under 60 years of
age is 5% within a year following diagnosis of these diseases and 24% within three
years, it is 34% and 54%, respectively, in those over 60 years; among those over
70 years, 75% die within a year. Half of the patients over 70 years developed
hepatocellular carcinoma, usually against the background of liver cirrhosis.
 It can thus be concluded that disturbances in certain components of the immune
system of the elderly produce a whole range of symptoms that appear vague as
compared to the corresponding nosological disease forms proper. However, it is
them that shape the image of an elderly person: retarded reactions, stiffness, lack of
locomotor coordination, forgetfulness, muscular weakness etc.
On the one hand, one could wish the Creator or Nature itself (depending on the
personal outlook) had been wiser and put more secure barriers to the development
of autoimmune processes. On the other hand though, it might have been their
wisdom at its best, because, had it happened the other way round, life could last
indefinitely long and, if these minute errors in the immune and metabolic
processes cannot be efficiently prevented from accumulation, other difficult
problems would pile up as a result.
This is how the picture of homeostatic disorders leading to premature ageing
becomes clearer and clearer. These vicious circles of interdependent disturbances
can only be broken with timely elimination of all pathological products from the
body. The only efficient way for this is efferent therapy, primarily plasmapheresis.
The next question is when should this therapy be started? Should we wait
until the manifest symptoms of ageing develop or should we prevent them from
developing? Naturally, the latter!
A timely primary disease prevention will also serve as a primary prophylaxis of
premature ageing. The cornerstone of this prophylaxis is efferent therapy, which
aims at elimination of what is already evident and what has not shown yet.
This measure can be indicated at any age, when microsymptoms develop
suggestive of an abnormal state of health: too rapid fatigability; unusual sensations
or dull ache in the joints or elsewhere in the body; abnormal appearance of the
sclerae, hair, or nails; wrinkles in the facial or hand skin; memory disorders or
tinnitus; changes in the gait, flexibility, or locomotor coordination; impotence and
so on. Of course, not a single symptom out of this range but a set of them should
draw attention, especially if they persist for many days and weeks. Arterial blood
pressure elevation should not be ignored (as natural or age-related), nor ache
or discomfort in the heart area, even if it can be quickly cut short with drugs
there is no smoke without a fire. It means that atherosclerosis, one of the major
heralds of ageing, is sneaking up.
One of the manifestations of the female bodys involution is climacteric
syndrome. This period when the hormonal status is overhauled brings forth a
number of specific climacteric symptoms hot flushes, sensation of heat,
hyperperspiration, and irritability which worsen the womans well-being and
quality of life for quite a while. Dysfunction affects not just the ovaries, but also
other endocrine glands, e. g. thyroid, and symptoms of autoimmune thyroiditis can
develop. Metabolic processes are derailed and enzymatic activity is reduced, which
is seen in the example of succinate dehydrogenase, a marker of mitochondria and
energetic processes in the Krebs cycle.
When conventional therapeutic measures are useless, plasmapheresis courses
can rather quickly eliminate the symptoms mentioned above, especially in a
recently developed climacteric syndrome, when these symptoms are volatile and
there are no pronounced psychovegetative disorders.
Still, plasmapheresis is also indicated for older people, although one cannot
hope for considerable regression of organic and systemic disorders already in
place. However, even in coronary artery disease with marked clinical
manifestations, obliterating atherosclerosis of the lower extremities, and
polyarticular rheumatoid arthritis, plasmapheresis courses help achieve substantial
subjective, clinical, and laboratory improvements.
Therefore, preventive efferent therapy should be based on a yearly
plasmapheresis course; quantum therapy should be added when signs of
immunosuppression or allergy develop. These measures can also be viewed as a
primary prophylaxis of malignancies. Ozone therapy should be kept in mind, too.
Administered periodically, it helps repair the mechanisms that support the
universal electrostatic stability of homeostasis, prevent pathological
biotransformation of the cellular cytoplasm, and reduce the risk of oncological
diseases.

Membrane plasmapheresis on the device Hemofenix.

Comparative characteristic.

Work with this device represent in our opinion to be the best option. With
success can be used and in practice of intensive therapy and reanimation, and for
treatment of patients with chronic pathology.
It doesn't have competition in pediatric practice at patients with body
weight less than 10 kg, aged 3-6 months, and all this is as device is concern,
but our membrane !!!! is use with syringe for premature baby from 700g
which concern neonatology most important.
It has a number of advantages in the emergency conditions as being portable
and easily transported (in a special case) the device can be deployed in any
conditions in the most unsuitable rooms including in system of ambulance and
medicine of accidents, epidemic and catastrophe
Important advantage is the one-needle type of connection to the patient. It is
especially valuable at "bad" veins, deficiency of venous access at extensive burns,
etc. It is possible to use any veins of a forearm and even a wrist with catheters
18-22G. No other device of such will allow,

Advantage is adaptability of the device to conditions of a venous intake and

return. The device almost itself chooses the most optimum perfusion
parameters for specific conditions duration and a intake and return of blood in
compliance with the set range of the maximum pressure in plasma filter blood
cameras.
It is provided automatic system of anticoagulant dosing with opportunity and
its thinner "manual" adjustment. After establishment of optimum doses of an
additive of anticoagulant and, if necessary, isotonic solution of sodium of chloride
to a blood stream, the device can work further practically in the automatic mode.
Only from time to time the quantity of the added drops, duration of phases, mainly
exile phases is controlled, and also completion of the extracted plasma volume is
periodically carried out by plasma substitutes, i.e. in the course of work it isn't
required excessively intense and constant control and any tiresome manipulations.
Therefore one operator quite can perform at the same time at least two operations
in one room.
By means of the device "Hemofenix" it is possible to carry out an intake of
plasma at donors also especially as in these conditions one-needle connection is
more preferable. Obtaining the demanded volume of plasma is made quickly
enough, and quality of the received plasma meets all requirements of service of
blood. Mobility of the device allows receiving an auto-plasma in the conditions of
surgical offices or directly on the course of operations, and also in separations of
intensive therapy from relatives. Besides, receiving more concentrated plasma with
the maintaining of the last to 85-90% in a filtrate, in comparison with 75% in usual
conditions that is important in treatment of seriously ill patients is possible.
Besides, the quantity of leukocytes in the received plasma is 10 times less
(0.0001x109/L), than according to the blood service requirements. That is, danger
of a sensitization decreases and need in special the leuko-depletion filters
disappears.
By means of the device "Hemofenix" it is possible to carry out with equal
success and a one-stage continuous plasma-sorption and even usual haemo
sorption, i.e. this device at all the simplicity and diminutiveness, can replace the
whole complex of the difficult equipment for providing any problems of
therapeutic apheresis and detoxication.

Considering the small volume of primary filling (to 70 ml), it with success
allows to carry out a plasma exchange or haemosorption at the patients who are
in a critical condition, even in the conditions of unstable haemodynamics and
threat of bleedings.
Simplicity and safety of a method of a membrane plasma exchange with the
device "Hemofenix" open possibilities of more widespread introduction of
therapeutic apheresis, up to out-patient and polyclinic practice and carrying
out a plasma exchange even in house conditions.
Besides, it must be kept in mind that by means of the plasma filter Rosa
and only one syringe it is possible to do plasma exchange at newborns and
even prematurely born babies with body weight to 700 g that is impossible any
other device.