Essentially, four major disease groups are treated with apheresis:
- Severe lipometabolic diseases
- Auto-immune diseases
- Microcirculatory disorders
- Diseases in which poisons (toxins) have accumulated in the body.
Treatment of lipid metabolic diseases
H.E.L.P. apheresis (heparin-induced extracorporeal LDL precipitation) is a blood purification procedure that removes LDL cholesterol, lipoprotein, and fibrinogen from the blood. It was developed in 1984 for the treatment of patients in whom the high concentration of lipids in the blood cannot be reduced to a sufficient extent due to congenital lipid metabolism disorders, despite diet and the administration of medication. Procedure: Blood is continuously taken from a vein in the patient’s arm using a cannula and passed through a so-called plasma filter. Here, the blood cells and the blood plasma, i.e. the non-cellular components of the blood, are separated from each other. The addition of heparin causes lipoprotein, LDL cholesterol or fibrinogen from the extracted blood plasma to bind to the heparin and precipitate the corresponding complexes (hence the name of the procedure: heparin-induced extracorporeal LDL precipitation; precipitation=precipitation). These complexes are separated with the aid of a filter. The unused heparin is then removed from the purified blood plasma, returning it to its normal physiological state. Through a second cannula, the patient continuously receives the separated blood cells back along with the purified blood plasma throughout the treatment period. During one apheresis treatment, a total of approximately 3000 ml of blood is purified. The concentration of LDL cholesterol, lipoprote in and fibrinogen is reduced by at least 60%. The treatment time depends on factors such as plasma volume and plasma flow rate and varies between 80 and 120 minutes. The flow properties of the blood are improved and the regulation of vascular width is optimized so that blood flow in the blood vessels increases again.
Treatment of immune diseases
A disturbed balance between pro-inflammatory and anti-inflammatory immune cells in the mucosa is the cause of Crohn’s disease and ulcerative colitis, both forms of chronic intestinal inflammation. Abdominal pain and bloody diarrhea are characteristic symptoms, and joints, eyes and skin may be affected by the inflammatory disease process. Studies have shown that patients with Crohn’s disease and ulcerative colitis particularly benefit from apheresis, which is largely free of side effects. Procedure: The patient is connected to an apheresis system via a vein in the arm. Blood is continuously drawn and the white blood cells are selectively removed from the blood. This results in a “redistribution” of white blood cells in the body, which obviously has a positive effect on the inflammatory process. The short-term withdrawal of leukocytes does not affect the patient. It has been found that five weekly treatments are suitable to interrupt an acute episode of intestinal inflammation and monthly therapies to maintain remission (i.e., the disease does not break out again). In Japan, cell sorption was subsequently approved for the treatment of ulcerative colitis. In Germany, there is currently no valid agreement with health insurance companies to cover the cost of treatment for Crohn’s disease or ulcerative colitis. Ask your doctor whether you might benefit from this treatment.
Treatment of heart muscle disease
Patients who have certain heart muscle diseases also do much better after apheresis. In idiopathic dilated cardiomyopathy (DCM), the left ventricle is dilated and therefore can pump blood only weakly. The resulting heart weakness (insufficiency) triggers further enlargement of the ventricle in a kind of vicious circle and exacerbates the heart failure until organ failure occurs. Immunological interactions are crucial for the development of DCM. Procedure: The patient’s own antibodies, which attack the heart muscle cells, are filtered out of the patient’s blood. The treatment usually lasts one week and only needs to be repeated in special cases. To date, several hundred patients with chronic myocardial insufficiency have been successfully treated at the German Heart Institute in Berlin.
Other application areas
Although little known, there is a wide range of applications for the different types of apheresis:
- Diabetic patients.
- Patients with age-related macular degeneration, a disease of the retina of the eye that leads to loss of central vision.
- After a hearing loss, apheresis leads to a significant improvement according to the available studies, because the filtering process significantly improves blood flow.
- After severe poisoning, such as sepsis (blood poisoning with bacteria), after mushroom poisoning or severe alcohol poisoning, the toxin is removed from the body with the help of blood washing. In many cases, however, the cost coverage by health insurance companies is not clarified, although the procedure is recognized in many other countries.
