RESUMEN
Since the mid 1970s, when membrane modules became available, plasma separation techniques have gained in importance especially in the past few years. The advantages of this method are a complete separation of the corpuscular components from the plasma and due to increased blood flow rate and higher efficacy. Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a poor prognosis without treatment. Therapeutic apheresis (TA) in combination with immunosuppressive therapies has led to a steady increase in survival rates over the last 40 years. The updated information on immunology and molecular biology of different immunologic diseases are discussed in relation to the rationale for apheresis therapy and its place in combination with other modern treatments. The different diseases can be treated by various apheresis methods such as therapeutic plasma exchange (TPE) with substitution solution, or with online plasma or blood purification using adsorption columns, which contain biological or non-biological agents. Here, the authors provide an overview of the most important pathogenic aspects indicating that TA can be a supportive therapy in systemic autoimmune diseases such as renal and neurological disorders. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Committee of the American Society for Apheresis are cited.
Asunto(s)
Enfermedades Autoinmunes/terapia , Eliminación de Componentes Sanguíneos/métodos , Enfermedades Renales/terapia , Enfermedades del Sistema Nervioso/terapia , Enfermedades Autoinmunes/complicaciones , Humanos , Enfermedades Renales/complicaciones , Enfermedades del Sistema Nervioso/complicacionesRESUMEN
The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases. Updated information on immunology and molecular biology of different immunological diseases is discussed in relation to the rationale for apheresis therapy and its place in combination with other modern therapies. With the introduction of novel and effective biologic agents, TA is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved in recent years, due in part to very aggressive therapy schemes. For the immunological diseases that can be treated with TA, the guidelines of the German Working Group of Clinical Nephrology and of the Apheresis Applications Committee of the American Society for Apheresis are cited. TA has been shown to effectively remove the autoantibodies from blood and lead to rapid clinical improvement.
Asunto(s)
Enfermedades Autoinmunes/terapia , Eliminación de Componentes Sanguíneos/métodos , Enfermedades Hematológicas/terapia , Enfermedades de la Piel/terapia , Autoanticuerpos/sangre , Enfermedades Hematológicas/inmunología , Humanos , Enfermedades del Sistema Inmune/terapia , Intercambio Plasmático/métodos , Guías de Práctica Clínica como Asunto , Enfermedades de la Piel/inmunologíaRESUMEN
Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a bad prognosis without treatment. Therapeutic apheresis in combination with immunosuppressive therapies has led to a steady increase in survival rates over the last 35 years. Here we provide an overview of the most important pathogenic aspects indicating that therapeutic apheresis can be a supportive therapy in some systemic autoimmune diseases, such as systemic lupus erythematosus, antiphospholipid syndrome, rheumatoid arthritis, and inflammatory eye disease. With the introduction of novel and effective biologic agents, therapeutic apheresis is indicated only in severe cases, such as in rapid progression despite immunosuppressive therapy and/or biologic agents, and in patients with renal involvement, acute generalized vasculitis, thrombocytopenia, leucopenia, pulmonary, cardiac, or cerebral involvement. In mild forms of autoimmune disease, treatment with immunosuppressive therapies and/or biologic agents seems to be sufficient. The prognosis of autoimmune diseases with varying organ manifestations has improved considerably in recent years, due in part to very aggressive therapy schemes.
RESUMEN
The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.
Asunto(s)
Eliminación de Componentes Sanguíneos/métodos , Lipoproteínas LDL/metabolismo , Aterosclerosis/sangre , Aterosclerosis/terapia , Humanos , Hiperlipidemias/metabolismo , Hiperlipidemias/terapia , Lipoproteína(a)/sangreRESUMEN
Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992-2007) evaluated silver-coated (54 patients) and noncoated (105 patients) implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface.
RESUMEN
Hemolytic-uremic syndrome (HUS) is a disease that can lead to acute kidney injury and often to other serious sequelae, including death. The disease is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. In view of the different courses of HUS, a minimum of three different pathogenetic types leading to HUS can be subdivided as follows: HUS caused by infection, idiopathic HUS (non-Shiga toxin HUS), and HUS in systemic diseases and after toxin exposure. The etiology and pathogenesis of HUS are not completely understood and its therapy is complicated. After the introduction of therapeutic apheresis as a supportive therapy in HUS, several authors reported successful treatment in more than 87% of treated patients. The supportive therapy is indicated basically in severe courses of HUS and is superior to available therapy interventions.
Asunto(s)
Eliminación de Componentes Sanguíneos , Síndrome Hemolítico-Urémico/fisiopatología , Síndrome Hemolítico-Urémico/terapia , Síndrome Hemolítico-Urémico/etiología , HumanosRESUMEN
In 1974, Wu and Hoak described a method for determining circulating platelet aggregates. This method was modified by Grotemeyer in 1983. The platelet reactivity index (PR) is based on the ratio of platelet aggregates in blood samples obtained in different buffer solutions. Platelet aggregates are resolved when blood is sampled in EDTA-buffer, but remain fixed when EDTA-formalin-buffer is used. Generally, the PR is preferred, because in vitro manipulations of platelets are not necessary, and the results are calculated. PR values above 1.05 are suspicious for elevated platelet aggregation. PR values above 1.2 indicate pathological changes in platelet aggregation. The PR is inexpensive (4.0 euro dollars) and rapid to perform. PR values were used successfully to identify nonresponders to secondary prophylaxis with acetylsalicylic acid (ASA), that is, patients suffering from stroke (33%) and patients after cardiac ischemia (18%). Furthermore, elevated PR values correlated significantly with the incidence of arterial thromboembolic complications. The PR correlated well in our prospective study with values received from the retention test Homburg (RT-H) and the platelet function analyzer (PFA-100). The data indicate that the values of the PR seem to be highly predictive for the evaluation of the ASA therapy. However, the PR is not feasible for the determination of the ASA overdosage.
Asunto(s)
Plaquetas/efectos de los fármacos , Monitoreo de Drogas/métodos , Inhibidores de Agregación Plaquetaria/farmacología , Pruebas de Función Plaquetaria/métodos , Aspirina/farmacología , Ensayos Clínicos como Asunto , Ácido Edético/farmacología , Femenino , Citometría de Flujo , Formaldehído/farmacología , Humanos , Activación Plaquetaria , Adhesividad Plaquetaria , Agregación Plaquetaria , Recuento de Plaquetas , Pruebas de Función Plaquetaria/economía , Pruebas de Función Plaquetaria/instrumentación , Embarazo , Estudios Prospectivos , Tromboembolia , Factores de TiempoRESUMEN
BACKGROUND: A new generation of automated hematology analyzers allows the rapid determination of various red cell (RBC) indexes, including the percentage of hypochromic mature RBCs (HYPOm) and the hemoglobin (Hb) content of reticulocytes (CHr). These indexes have not yet been validated as measures for the detection of iron deficiency in blood donors. STUDY DESIGN AND METHODS: Iron status was evaluated in a total of 1142 unselected prospective blood donors based on measurement of serum ferritin, soluble transferrin receptor, and Hb compared to RBC indexes provided by an automated hematology analyzer (Advia 120, Bayer HealthCare) including HYPOm and CHr. RESULTS: Assuming that the most precise measure for body iron storage is related to the logarithm of the ratio of soluble transferrin receptor to ferritin, the sensitivity of ferritin for the diagnosis of iron depletion was 89 percent compared to 57 percent for HYPOm and CHr, respectively, to 69 percent for the combination of both RBC indexes, and to 26 percent for Hb concentration. CONCLUSION: The RBC indexes HYPOm und CHr are significantly better screening measures for identification of iron depletion in blood donors than Hb.
Asunto(s)
Donantes de Sangre , Deficiencias de Hierro , Adolescente , Adulto , Anciano , Ferritinas/sangre , Hemoglobinas/análisis , Humanos , Persona de Mediana Edad , Receptores de Transferrina/sangre , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To assess the efficacy and safety of a pollen blocker crème for prophylaxis of symptoms in patients with seasonal or perennial allergic rhinitis. DESIGN: Double-blind, randomized, placebo-controlled, crossover study conducted from November 2001 through September 2002 in 2 outpatient centers in Germany and 1 in Russia. Ninety-one patients aged 18 to 55 years with at least a 2-year history of seasonal or perennial allergic rhinitis confirmed by history and positive skin test results were randomly assigned to receive pollen blocker cream (n = 43) or carboxymethylcellulose in gel (placebo) (n = 48) applied sparingly to the lower internal nose region 4 times daily for a total of 9 days. The efficacy of treatment was assessed by means of nasal provocation testing. The investigators assessed the nasal symptom severity scores (range, 0-6), and the changes in nasal airflow after allergen application were measured by anterior rhinomanometry. RESULTS: The median score fell from 4 to 1 after application of the pollen blocker cream (P<.001) and from 4 to 3 in the placebo group (P<.05). The difference between the 2 groups after the second provocation was highly significant (P<.001). The increase in airflow in response to treatment was roughly 20% in the blocker group compared with only about 10% in the placebo group, relative to an airflow rate (299 mL/s) measured after provocation on day 1. CONCLUSIONS: The blocker was significantly more effective than placebo and reduced the typical symptoms of allergic rhinitis in response to nasal challenge with allergen by nearly 60% (placebo reduced symptoms by 25%). The pollen blocker cream did not produce any adverse effects. Therefore, the efficacy of the investigational product can be rated as good.
Asunto(s)
Antiinflamatorios/uso terapéutico , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Adulto , Alérgenos/efectos adversos , Carboximetilcelulosa de Sodio , Estudios Cruzados , Dermatophagoides pteronyssinus , Método Doble Ciego , Femenino , Alemania/epidemiología , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Provocación Nasal , Polen/efectos adversos , Ventilación Pulmonar/fisiología , Rinitis Alérgica Perenne/etiología , Rinitis Alérgica Perenne/fisiopatología , Federación de Rusia/epidemiología , Resultado del TratamientoRESUMEN
The findings of a large prospective study designed to identify primary and/or secondary hemostatic disorders before surgical interventions are presented. A total of 5649 unselected adult patients were enrolled to identify impaired hemostasis before surgical interventions. Each patient was asked to answer a standardized questionnaire concerning bleeding history. Activated partial thromboplastin time (aPTT), prothrombin time (PT), and platelet counts (PC) including PFA-100 (platelet function analyzer): collagen-epinephrine (C/E), and collagen-ADP (C/ADP) were routinely done in all patients. Additional tests, bleeding time (BT), and von Willebrand factor (vWF: Ag) were performed only in patients with a positive bleeding history and/or evidence of impaired hemostasis; e.g., drug ingestion. The bleeding history was negative in 5021 patients (88.8%) but positive in the remaining 628 (11.2%). Impaired hemostasis could be verified only in 256 (40.8%) of these patients. The vast majority were identified with PFA-100: C/E (n=250; 97.7%). The other six patients with impaired hemostasis were identifiable solely based on the PT (n=2), PFA-100: C/ADP (n=2), and vWF: Ag (n=2). The PFA-100: C/ADP detected 199 patients (77.7%). The only abnormality found among patients with a negative bleeding history was a prolonged aPTT due to lupus anticoagulant in nine patients (0.2%). The sensitivity of the PFA-100: collagen-epinephrine was the highest (90.8%) in comparison to the other screening tests (BT, aPTT, PT, vWF: Ag). The positive predictive value of the PFA-100: collagen-epinephrine was high (81.8%), but the negative predictive value was higher (93.4%). The use of a standardized questionnaire and, if indicated, the PFA-100: C/E and/or other specific tests not only ensure the detection of impaired hemostasis in almost every case but also a significant reduction of the cost.
Asunto(s)
Trastornos de la Coagulación Sanguínea/diagnóstico , Cuidados Preoperatorios/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antígenos/análisis , Coagulación Sanguínea/efectos de los fármacos , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/epidemiología , Trastornos de la Coagulación Sanguínea/genética , Pruebas de Coagulación Sanguínea , Colágeno/farmacología , Procedimientos Quirúrgicos Electivos , Epinefrina/farmacología , Femenino , Fibrinógeno , Humanos , Masculino , Tamizaje Masivo , Registros Médicos , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Activación Plaquetaria/efectos de los fármacos , Pruebas de Función Plaquetaria/instrumentación , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Trombofilia/sangre , Trombofilia/diagnóstico , Trombofilia/epidemiología , Factor de von Willebrand/inmunologíaRESUMEN
Infection, thrombosis, and stenosis are among the most frequent complications associated with blood-contacting catheters. Complications resulting from infection remain a major problem for hemodialysis catheters, with significant numbers of catheters being removed due to catheter-related sepsis. Numerous strategies have been employed to reduce the occurrence of infection and im-prove long-term outcomes, with varying degrees of success. The most important is the careful and sterile handling by the attending staff of the catheters during hemodialysis treatments to minimize or stop a microbial colonization of the skin and the catheter. Another approach is coating the external surface of the catheters with substances which are antibacterial like silver and/or substances with low thrombogenicity like silicone. This investigation reviews results of animal and clinical experiments conducted to assess the efficacy and biocompatibility of silver and silicone coated dialysis catheters. It is concluded that silver coatings can reduce bacterial colonization and occurrence of infection associated with these devices. The catheters employing ion implantation of silicone rubber showed low thrombogenicity. Results of the studies indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters. A new development is the microdomain structured surface (PUR-SMA coated catheters). Preliminary results with these catheters are very encouraging.
Asunto(s)
Infecciones Bacterianas/prevención & control , Catéteres de Permanencia/microbiología , Materiales Biocompatibles Revestidos , Diálisis Renal , Animales , Derivación Arteriovenosa Quirúrgica , Catéteres de Permanencia/efectos adversos , Contaminación de Equipos , Seguridad de Equipos , Humanos , Diálisis Renal/efectos adversos , Elastómeros de Silicona , PlataRESUMEN
Catheters for large vessels have become essential tools for the management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as infection, sepsis, and thrombosis. In two retrospective studies, the first (1979-1990) with 1672 patients and 2626 large-bore catheters and the second (1996-2001) with 182 patients and 332 acute catheters, the frequency of infections, thrombosis, bleeding, and other side-effects were investigated. All complications and side-effects are presented. In total, the complication rate was in the first study 27.7% (internal jugular vein 23.8% in 2105 catheters, subclavian vein 43.5% in 521 catheters) and in the second study 32.2% (internal jugular vein 20% in 231 catheters, subclavian vein 60.6% in 94 catheters, femoral vein 57.1% in 7 catheters). The majority of complications were puncture not possible, puncture of the artery abscess, septicemia, bleeding, thrombosis, and faults in catheter material. To minimize these complication rates the handling of the inserted catheters before, during, and after the hemodialysis or apheresis treatment is minimized.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia , Diálisis Renal/efectos adversos , Eliminación de Componentes Sanguíneos , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Vena Femoral , Humanos , Venas Yugulares , Diálisis Renal/instrumentación , Vena SubclaviaRESUMEN
In a prospective study, 254 of 5649 unselected patients scheduled for surgery at our hospital were identified preoperatively as having either acquired (n=182) or inherited (n=72) impaired primary hemostasis (platelet dysfunction including von Willebrand disease). All patients were initially pretreated with desmopressin (DDAVP). Response to DDAVP or subsequent treatment(s) was defined as correction of any one of the abnormal PFA-100 platelet function tests. The non-responders were additionally treated with tranexamic acid or aprotinin; those with von Willebrand disease (vWD) received factor VIII concentrates with von Willebrand factor (vWF). Those still unresponsive to therapy received conjugated estrogens and, as a last attempt, a platelet transfusion. The administration of DDAVP led to a correction of platelet dysfunction in 229 of the 254 patients treated (90.2%). Tranexamic acid was effective in 12 of 16, aprotinin in 3 of 5, and factor VIII concentrates with vWF in all 4 patients with unresponsive to DDAVP. The remaining 6 patients were pretreated with conjugated estrogens, and 2 of these patients were additionally treated with platelet transfusion. The frequency of blood transfusion was lower, but not statistically significant (9.4% vs. 12.2%: p = 0.202) in preoperatively treated patients with impaired hemostasis than in patients without impaired hemostasis. In a retrospective group, the frequency of blood transfusion was statistically significant higher (89.3% vs. 11.3%: p < 0.001) in patients without preoperative correction of impaired hemostasis than in patients without impaired hemostasis. Preoperative correction of impaired primary hemostasis is possible in nearly all patients affected, and results in a reduction of homologous blood transfusions.
Asunto(s)
Trastornos de las Plaquetas Sanguíneas/terapia , Hemostasis , Cuidados Preoperatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Tiempo de Sangría , Trastornos de las Plaquetas Sanguíneas/tratamiento farmacológico , Trastornos de las Plaquetas Sanguíneas/fisiopatología , Trastornos de las Plaquetas Sanguíneas/cirugía , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Transfusión Sanguínea , Desamino Arginina Vasopresina/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de von Willebrand/tratamiento farmacológico , Enfermedades de von Willebrand/fisiopatología , Enfermedades de von Willebrand/cirugíaRESUMEN
Vascular catheters have become essential tools for management of hospitalized or chronically ill patients requiring intensive medical treatments such as extracorporeal detoxification procedures. The increased use of such devices has been accompanied by a corresponding increase in complications, such as bloodstream infection and thrombosis. In a retrospective study 332 large bore catheters which were inserted in 182 patients in the inferior or superior vena cava were investigated. The complication rate was in internal jugular vein puncture (N = 231) with 20% low and in the subclavian vein puncture (N = 94) with 60.5% and in the femoral vein puncture (N = 7) with 57.1% very high. The majority of complications were puncture not possible, puncture of the artery, abscess, septicemia, bleeding and thrombosis. To minimize the complication rate the surface of some catheters were treated and the microdomain structured surface inserted. The first results are very encouraging and should help to make large bore catheters safer.
Asunto(s)
Eliminación de Componentes Sanguíneos/instrumentación , Cateterismo Venoso Central/efectos adversos , Femenino , Vena Femoral , Humanos , Venas Yugulares , Masculino , Persona de Mediana Edad , Poliuretanos , Vena Subclavia , Resultado del TratamientoRESUMEN
Infection, thrombosis, and stenosis are among the most frequent complications associated with blood-contacting catheters. These problems are usually related to surface properties of the base catheter material. Surface treatment processes, such as ion implantation and ion beam assisted deposition (IBAD) and microdomain structured surfaces, can be used to mitigate such complications. This study evaluated silver coated and implanted large bore catheters used for extracorporeal detoxification. In a 186 patient prospective study, 225 large bore catheters were inserted into the internal jugular or subclavian veins. Eighty-five surface-treated catheters (Spi-Argent, Spire Corporation, Bedford, MA, USA) and 28 catheters with surface treatment (Spi-Silicone, Spire Corporation) were inserted in 90 patients. One hundred and twelve untreated catheters placed in 96 patients served as controls, After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using a scanning electron microscope (SEM). Bacterial colonization was observed in 8% of the treated catheter compared with 46.4% of untreated catheters. The SEM investigations showed all treated catheters to possess low thrombogenicity. Catheters with microdomain structured surfaces showed same results in preliminary observation. The surface treatments of the large bore catheters can be used to improve thrombus and infection resistance of blood contacting catheters.
Asunto(s)
Eliminación de Componentes Sanguíneos/instrumentación , Cateterismo Venoso Central , Catéteres de Permanencia , Diálisis/instrumentación , Infecciones Bacterianas/etiología , Infecciones Bacterianas/prevención & control , Estudios de Casos y Controles , Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/efectos adversos , Materiales Biocompatibles Revestidos , Humanos , Venas Yugulares , Microscopía Electrónica de Rastreo , Estudios Prospectivos , Plata , Vena Subclavia , Propiedades de SuperficieRESUMEN
Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lpa) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein a (Lpa), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.