Notfall & Hausarztmedizin 2006; 32(4): 176-182
DOI: 10.1055/s-2006-943528
Notsituation

© Georg Thieme Verlag Stuttgart · New York

Gesicherte Indikationen zur Plasmapherese-Therapie bei internistischen und neurologischen Notfällen

Elimination pathogener SubstanzenElimination of pathogenic substances - confirmed indications for plasmapheresis in internistic and neurological emergenciesMichael J. Koziolek1 , Gerhard A. Müller1
  • 1Abteilung Nephrologie und Rheumatologie, Georg-August-Universität Göttingen
Further Information

Publication History

Publication Date:
17 May 2006 (online)

Die Apherese-Therapie besteht aus der extrakorporalen Elimination pathogener Proteine, proteingebundener pathogener Substanzen oder pathogener Zellen des Blutes. Die gegenwärtige Situation der Apherese ist durch wachsende technische Möglichkeiten und Erfolge bei schwerwiegenden Erkrankungen gekennzeichnet. Leider fehlen für viele Indikation prospektive, randomisierte Studien. Dies schränkt einen breiteren Einsatz der zum Teil doch recht kostenintensiven Verfahren erheblich ein. Für einige wenige Indikationen liegen Studien der Evidenzklasse I vor beziehungsweise sind initiiert.

Apheresis treatment comprises the extracorporeal elimination of pathogenic proteins, protein-bound pathogenic substances or pathogenic blood cells. The current situation with regard to therapeutic apheresis is characterised by an increase in the technical possibilities available, and successful outcomes in serious diseases. Unfortunately, however, prospective randomized studies are lacking for numerous indications. This places considerable constraints on a more widespread application of this far from inexpensive procedure. For a limited number of indications, evidence class I studies are available or have been initiated.

Literatur

  • 1 Bosch T. New trends in apheresis.  Ther Apher. 2001;  5 323-324
  • 2 Koziolek MJ, Strutz F, Kochsiek T, Müller GA. Therapieoptionen mittels Apherese bei internistischen und neurologischen Krankheitsbildern.  Nephro News. 2004;  6 1-6
  • 3 Sanjay R, Flanagan J, Sodano D. et al. .The acute phase reactant, fibrinogen, as a guide to plasma exchange therapy for acute Guillain-Barré syndrome. J Clin Apher [Epub ahead of print] 2005
  • 4 Schilling S, Linker RA, Konig FB, Koziolek M. et al. .Plasma exchange therapy for steroid-unresponsive multiple sclerosis relapses Clinical experience with 16 patients. Nervenarzt 2005
  • 5 Keegan M, König F, McCelland R. et al. . Relations in humoral patholgical changes in multiple sclerosis and response to therapeutic plasma exchange.  Lancet. 2005;  366 579-582
  • 6 Wyllie BF, Garg AX, Macnab J, Rock GA, Clark WF. Members of the Canadian Apheresis Group. . Thrombotic thrombozytopenic purpura/haemolytic uremic syndrome: a new index prediciting response to plasma exchange.  BJH. 2005;  132 204-209
  • 7 Kassenärztliche Bundesvereinigung: Mitteilungen: Zum Beschluss des Bundesausschusses der Ärzte und Krankenkassen vom 24. 3. 2003 zu den therapeutischen Apheresen.  Deutsches Ärzteblatt. 2003;  30 2035-2036
  • 8 Bosch T. Recent advances in therapeutic apheresis.  J Artif Organs. 2003;  6 1-8
  • 9 Sasso EH, Merrill C, Furst TE. Immunoglobulin binding properties of the Prosorba immunoadsorption column for treatment of refractory arthritis.  Ther Apher. 2001;  5 84-91
  • 10 Felson DT, LaValley MP, Baldassare AR. et al. . The Prosorba column for treatment of refractory rheumatoid arthritis.  Ther Apher. 1999;  42 2153-2159
  • 11 Gendreau RM. A randomized dopple-blind sham-controlled trial of the Prosorba immunoadsoprtion column in treatment of rheumatoid arthritis.  Ther Apher. 2001;  5 79-83
  • 12 Klingel R, Fassbender C, Fassbender T. et al. . Rheopheresis: rheologic, functional and structural aspects.  Ther Apher. 2000;  4 348-357
  • 13 Klingel R, Fassbender C, Fischer I. et al. . Rheopheresis for age-related macular degeneration: a novel indication for therapeutic apheresis in opthalmology.  Ther Apher. 2002;  6 271-281
  • 14 The Multicenter Investigation of Rheopheresis for AMD (MIRA-1) Study Group. . Multicenter prospective, randomized, douple-masked, placebo-controlled study of rheopheresis to treat non-exudative age-related macular degeneration: interin analysis.  Trans Am Opthalm Soc. 2002;  100 85-108
  • 15 Fell AJ, Engelmann K, Richard G. et al. . Rheopherese: Ein systemischer Therapieansatz für die altersabhängige Makuladegeneration?.  Ophthalmologe. 2002;  99 780-784
  • 16 Suckfüll M, Seidel D, Thiery J. et al. . Behandlung des Hörsturzes durch Fibrinogen-LDL-Apherese.  Z Kardiol. 2003;  92 59-63
  • 17 Suckfüll M. Fibrinogen and LDL apheresis in treatment of sudden hearing loss: a randomized multicenter trial.  Lancet. 2002;  360 1811-1817
  • 18 Klingel R, Mumme C, Fassbender T. et al. . Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial.  Ther Apher Dial. 2003;  7 444-455
  • 19 Ramunni A, Giancipoli G, Saracino A. et al. . LDL-apheresis in acute anterior ischemic optic neuropathy.  Int J Artif Organs. 2004;  27 337-341
  • 20 Staudt A, Staudt Y, Dörr M. et al. . Potential role of humoral immunity in cardiac dysfunction of patients suffering from dilated cardiomyopathy.  JACC. 2004;  44 829-836
  • 21 Felix FB, Staudt A, Dörffel WV. et al. . Haemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilatated cardiomyopathy.  Am J Coll Cardiol. 2000;  35 1590-1598
  • 22 Knebel F, Böhm M, Staudt A. et al. . Reduction of morbidity by immunoadsorption therapy in patients with dilated cardiomyopathy.  Int J Cardiol. 2004;  97 517-520
  • 23 Dörffel DV, Wallukat G, Dörffel Y. et al. . Immunoadsoprtion in idiopathic cardiomyopathy, a 3-year follow-up.  Int J Cardiol. 2004;  97 529-534
  • 24 Hessel FP, Wegner C, Müller J. et al. . Economic evaluation and survival of immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy.  Eur J Health Econom. 2004;  5 58-63
  • 25 Bohmig GA, Regele H, Exner M. et al. . C4d-positive acute humoral renal allograft rejection: effecitve treatment by immunoadsorption.  J Am Soc Nephrol. 2001;  12 2482-2489
  • 26 Shah A, Nadasdy T, Arend L. et al. . Treatment of C4d-positive acute humoral rejection with plasmapheresis and rabbit polyclonal antithymocyte globulin.  Transplantation. 2004;  77 1399-1405
  • 27 Yamaji K, Tsuda H, Hashimoto H. Current topics on cytapheresis technologies.  Ther Apher. 2001;  5 287-292
  • 28 Shibata H, Kuriyama T, Yamawaki N. Cellsorba.  Ther Apher Dial. 2003;  7 44-47
  • 29 Shirokaze J. Leukocytapheresis using a leukocyte removal filter.  Ther Apher. 2002;  6 261-266
  • 30 Saniabadi AR, Hanai H, Takeuchi K. et al. . Adacolumn, an adsorptive carrier based granulocyte and monocyte apheresis device for the treatment of inflammatory and refractory diseases associated with leukocytes.  Ther Apher Dial. 2004;  7 48-59
  • 31 Hasegawa M, Kawamura M, Kasugai M. et al. . Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis: report of five cases.  Ther Apher. 2002;  6 443-449
  • 32 Nakamura T, Suzuki Y, Koide H. Granulocyte and monocyte adsorption apheresis in a patient with antglomerular basement membrane glomerulonephritis and active ulcerative colitis.  Am J Med Sci. 2003;  325 296-298
  • 33 Yamasaki S, Ueki Y, Nakamura H. et al. . Effect of filtration leukocyteapheresis therapy: modulation of white blood cell enzyme activities in patients with rheumatoid arthritis.  Artif Organs. 2002;  26 378-384
  • 34 Yokoyama H, Shimizu M, Wada T. et al. . The beneficial effect of lymphocytapheresis for treatment of nephrotic syndrome.  Ther Apher. 2002;  6 167-173
  • 35 Hanai H, Watanabe F, Takeuchi K. et al. . Leukocyte adsorptive apheresis for the treatment of active ulcerative colitis: a prospective, uncontrolled, pilot study.  Clin Gastroenterol Hepatol. 2003;  1 28-35
  • 36 Nagase K, Sawada K, Ohnishi K. et al. . Complication of leukocytapheresis.  Ther Apher. 1998;  2 120-124
  • 37 Tsukada Y, Nakamura T, Iimura M. et al. . Cytokine profile in colonic mucosa of ulcerative colitis correlates with disease activity and response to granulocytapheresis.  Am J Gastroenterol. 2002;  97 2820-2828
  • 38 Koziolek MJ, Strutz F, Kochsiek T, Bramlage CP, Müller GA. Indikationen zur Plasmapherese im internistischen und neurologischen Bereich.  Mitteilungen DAGKN. 2005;  XXXIV 151-166

Anschrift für die Verfasser

Dr. med. Michael J. Koziolek
Prof. Dr. med. Gerhard A. Müller

Abteilung Nephrologie und Rheumatologie

Georg-August-Universität Göttingen

Robert-Koch-Str. 40

37075 Göttingen

Phone: 0551/396331

Fax: 0551/398906

Email: mkoziolek@med.uni-goettingen.de

    >