Plasmaaustauschbehandlung bei systemischen Vaskulitiden

Zusammenfassung

Der therapeutische Plasmaaustausch ist als extrakorporales Blutreinigungsverfahren zur Elimination höhermolekularer Plasmabestandteile geeignet. Hierzu zählen u. a. pathogene Antikörper, Immunkomplexe, Kryoglobuline oder Leichtketten. Zu den durch randomisiert-kontrollierte Studien bestätigten Behandlungsindikationen gehören auch systemische Vaskulitiden mit schwerer Nieren- und/oder Lungenbeteiligung. Metaanalysen bisheriger Studien bestätigen die eindeutige Wirksamkeit des Plasmaaustausches bzgl. der Sicherung einer dialyseunabhängigen Nierenfunktion. Für die wirksame Beseitigung von Autoantikörpern sind fünf bis sieben Behandlungen innerhalb von sieben bis zehn Tagen optimal. Um nach der Apherese eine Resynthese der pathogenen Antikörper zu verhindern, ist eine synchronisierte immunsuppressive Therapie erforderlich. Der Plasmaaustausch kann, je nach Krankheitsbild, Stadium und Gerinnungssituation, gegen verschiedene Substituate erfolgen. Behandlungen mit FFP (Fresh Frozen Plasma) sind deutlich häufiger mit Nebenwirkungen verbunden als der Austausch gegen Albuminlösungen.

Summary

Therapeutic plasma exchange is an extracorporeal blood purification technique appropriate for the removal of large molecular weight substances from the plasma. Such substances include pathogenic antibodies, immune complexes, cryoglobulins, myeloma light chains. Reflecting evidence from randomized controlled studies today the highest indication categories include systemic vasculitides with severe renal involvement and/or pulmonary hemorrhage. Metanalysis of previous studies confirm a clear benefit of plasma exchange to preserve dialysis independent renal function. For effective immunoglobulin elimination 5 to 7 plasma exchanges within 7 to 10 days are optimal. In order to avoid immunoglobulin resynthesis, additional simultaneous immunosuppressive therapy is required. Depending on indication, different replacement fluids, removal rates and frequencies are recommended. Adverse reactions are substantially more common with fresh frozen plasma (FFP) than with albumin replacement.

Schlüsselwörter

Apherese - Plasmaaustausch - Vaskulitis - Glomerulonephritis

Keywords

Apheresis - plasma exchange - vasculitis - glomerulonephritis

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