PLASMAPHERESIS AND IMMUNOADSORPTION - DIFFERENT TECHNIQUES AND THEIR CURRENT ROLE IN MEDICAL THERAPY

In the last 30 years, several studies have documented the effect of pl amapheresis and immunoadsorption in eliminating pathogenic autoantibod ies (ABs) and immune complexes (ICs) from circulation. These extracorp oreal therapies are still not accepted as first line options, which ma y be due to existing controlled studies failing to confirm any obvious benefit. Today, indications for plasmapheresis are idiopathic-thrombo cytopenic purpura (ITP), thrombotic-thrombocytopenic purpura (TTP), an d also cryoglobulinemia during the course of systemic rheumatic diseas es and Goodpasture's syndrome. In acute flares and severe organ manife stations, extracorporeal therapies may be helpful as a complement to i mmunosuppressive therapy. Immunoadsorption offers some advantages comp ared with plasmapheresis; however, to date only avoidance of substitut ion fluids has really been used. The new therapeutic options given by immunoadsorbers, that is, a continuous application in acute disease st ates or chronic use instead of immunosuppressive drugs, have still to be evaluated in systemic autoimmune diseases. Most experiences have us ed immunoadsorbent columns in the pretransplantation treatment of pati ents with high panel reactivity and in patients with ITP. Results indi cate excellent biocompatibility and a good clinical response. Randomiz ed controlled trials are mandatory to give continued support to the th erapeutic opportunities offered only by immunoadsorption; the limited number of patients suitable for this therapy necessitates multicentric cooperation.