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Therapeutic Apheresis procedures: mechanisms of action and Immunomodulatory effects

In plasmapheresis or plasma exchange, circulating plasma is eliminated by apheresis (centrifugation) or haemofiltration through a membrane. The procedure of centrifugation separates the specific blood components by weight, allowing for the removal of plasma and reinfusion of the other blood components. The procedure of haemofiltration uses a filter that allows the passage of erythrocytes, leucocytes and platelets while retaining and effectively eliminating plasma and its components. Plasma that is removed is usually replaced by fresh-frozen plasma, albumin, or colloidal and/or crystalloid solutions [1–3]. Certain components such as albumin, cholesterol and immunoglobulins can be removed almost in their entirety. Nevertheless, plasmapheresis leads to a decrease in the concentration of all plasma proteins, with repeated and continuous treatment leading to a decrease of coagulation factors, fibrinogen and immunoglobulins (Table 1). In addition, another technique combines centrifugation and life 18® filtration through two magnetic disks and a membrane (rotation separates blood components leading the plasma to a filter membrane that separates the plasma components) [1]. Several selective apheresis have been developed to eliminate specific plasma components pathologically involved in several diseases.