[Therapeutic plasma exchange with particular regard to the perioperative period].
The end of the last decade of the XXth century caused that therapeutic plasma exchanges have found an important place in the therapeutic management of many pathological conditions. This was possible owing to the knowledge of the pathophysiology of many diseases and pathological factors present in circulation. Therapeutic plasma exchange is the procedure during which pathological substances are removed from patient's circulation without causing anaemia and oncotic pressure disturbances. The procedures are carried out in order to eliminate pathological components of the plasma. Therefore, the general indication to plasma exchange are disease entities, the pathogenesis of which depends on plasma composition abnormalities. The understanding of the mechanisms of action of therapeutic plasma exchange, pathogenesis of certain diseases, and results of controlled studies of procedure effectiveness made possible to establish the indications to the procedure. In view of varying indications to therapeutic plasma exchange, in the paper these indications are discussed which are of importance in perioperative period. In clinical practice, therapeutic plasma exchange in myasthenia gravis has been applied, among other, in acute states in order to stabilize patient's condition after thymectomy or during preparation for thymectomy. The resistance occurring to preparations of blood-clotting factors is the cause of their ineffectiveness in control of bleeding. Application of plasma exchange and removal of antibodies make possible to achieve sensitivity of patient's organisms to exogenous blood-clotting factors. Good effects were observed in the treatment of hepatic coma in which application of the procedures frequently enables survival until performing transplantation. Therapeutic plasma exchange is the method of symptomatic treatment. The procedures may enable or facilitate management of patients in preoperative or postoperative periods but they cannot cause permanent cure.
Korsak
J
J
Zakład Transfuzjologii i Transplantologii (Centralny Bank Krwi) Centralny Szpital Kliniczny Wojskowej Akademii Medycznej im. gen. dyw. B. Szareckiego w Warszawie.
D006801:Humans; D016031:Liver Transplantation / Q000379:methods; D019990:Perioperative Care / Q000379:methods*; D010951:Plasma Exchange / Q000379:methods*; D013934:Thymectomy / Q000379:methods