1. MEMBRANE PLASMAPHERESIS
DR OLEG TITKOV
Scientific and production complex "Alpha" of
“TRACKPORE TECHNOLOGY Corporation“.
The company was built in 2002.
The main products are: membrane "Rosa" plasma
filters and “HEMOFENIX” devices for therapeutic
and donor plasmapheresis and hemosorption.
2. Production technology of membrane plasmafilter.
Specialized industrial cyclotron “ALFA”
In cooperation with scientists from the Joint Institute of Nuclear Research
(JINR) our company designed and built the first industrial cyclotron in Russia
and CIS and the world's first specialized irradiation complex for production of
track membranes.
3. Production technology of
membrane plasmafilter
Today scientific and production complex “Alfa"
is a unique complex corresponding to the
requirements of ISO 9001 и ISO 13485
standards, has serial production of track
membranes (with pore diameter 400
nanometers), and medical equipment for
plasmapheresis.
In clean premises there are held all
technological operations on assembling
“ROSA” plasma filters and their 100%
multistage control.
Annual production - 300,000 "Rosa"
plasmafilters and 500 “HEMOFENIX" devices.
In July 2010 "Trackpore Technology
Corporation" received an international quality
certificate of CE for the goods produced.
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8. Electron microscopic
pictures of track membrane
Membrane plasmapheresis is
based on the use of track
membranes
Track membrane is a thin polymeric film
with through pores. It is produced by
physicochemical treatment of a lavsan
film irradiated with accelerated charged
particles of the inert argon gas.
Characteristics of the track membrane:
- pore diameter - within the range of 0.4
microns,
- thickness - 10 microns.
9. Membrane plasmapheresis
Device and plasma filter created by constructers of our
company are designed for performing therapeutic and
donor membrane plasmapheresis.
Therapeutic plasmapheresis is one of the methods of efferent
therapy aimed to eliminate various pathologic elements
(autoantibodies, immune complexes, natural
metabolites, toxic substances of exo- or endogenous
origin) from the organism.
Therapeutic plasmapheresis is
used with high efficiency in
prevention of occupational and
autoimmune
diseases, therapy, oncology, obstet
rics and
gynecology, perinatology, and
pediatrics, in cases of mass
poisoning, in treatment of drug and
alcohol abuse, prevention of
premature aging, strengthening of
reproductive health.
11. “ROSA” plasma filter
The main technical characteristics of “ROSA”
plasma filter:
•Speed of blood flow not less than 40 ml/min
•Volume of initial blood filling not more than 20
ml
•Weight 100 g
•Size – 85х85х35 mm
Advantages of plasmafilter “ROSA”:
•High productivity and safety
•Solid body and stable filtration process
•Possibility of erythrocytes’ penetration is
eliminated
•Possibility of damaging blood formed
elements is eliminated
•Donor plasma corresponds to the
requirements of European Pharmacopeia and
Plasmafilter is a disposable sterile product can be used for donation and production of
which is completed with a disposable line deficit blood preparations including albumin,
for performing plasmapheresis. immunoglobulin, antihemophilic preparations.
12. Device for membrane therapeutic and donor plasmapheresis
AMPld-TT, trade mark “HEMOFENIX”
Application of “HEMOFENIX” device allows to perform:
• Therapeutic plasmapheresis in different spheres of
medicine including obstetrics and
gynecology, narcology, resuscitation, treatment of
autoimmune diseases, dermatology, pediatrics, disaster
medicine.
• Donor plasmapheresis in Blood Service
Advantages of “HEMOFENIX” device
• Completely automatic plasmapheresis procedure
•Safety assurance
• Comfortable use
• Portability
• Comfortable transporting case
Main characteristics of “HEMOFENIX” device
• Blood productivity up to 100 ml/min
Continuous process of membrane • Volume of plasma received - 800 ml/h
plasmapheresis with “HEMOFENIX”
device is performed on a single- • Dosed anticoagulant supply
needle scheme. Volume of initial • Period of continuous work up to 10 hours
extracorporal circuit filling– 65 ml.
• Weight 14,5 kg
• Size 450х320х120 mm
• Power consumption 100 W
13. Efferent therapy methods based on
filtration:
PLASMAPHERESIS – plasma elimination with the help of
plasmafilter.
PLASMAFILTRATION – filtration of plasma through fiber
filters.
Indications: familial hypercholesterolemia,
cryoglobulinemia, Sjogren's syndrome, rheumatoid
vasculitis, polyneuropathy.
CASCADE PLASMAFILTRATION – plasma filtration
through the system, consisting of 2 different filters.
14. Efferent therapy methods based on
sorption:
HEMOSORPTION – elimination of exo- and endotoxins by
blood perfusion through sorbent.
PLASMASORPTION – elimination of exo- and endotoxins by
plasma perfusion through sorbent.
Sorbents: nonspecific (activated carbons, ion-exchange and
oxidation sorbents) and specific (receptor - remove protease; affinity -
LDL, Ig; immunosorbents - Ig, LDL, antibodies to IX factor, antibodies
to DNA, Ig, E).
16. Laboratory monitoring data during the donor membrane
plasmapheresis with “HEMOFENIX” device
Blood
Blood Requirement
Parameter before Plasma
after PhM s
PhM
3,8 0,2 х 3,7 0,1 х 0,005 0,0012
Erythrocytes <0,1 х 109/l
1012/l 109/l х 109/l
Leucocytes х 109/l 7,3 0,2 7,25 0,16 0,003 0,001 <0,1
Thrombocytes х 109/l 200 18 180 12 4,4 1,2 <10,0
Free hemoglobin, g/l <0,1 <0,1 <0,1 <0,1
Content of VIII factor, МЕ
1,1 0,07 - 1,1 0,06 >0,7
Content of the whole
protein, g/l 60-80 - 57,2 1,3 >55
17. The main plasmapheresis effects
DETOXICATION
• elimination of toxic substances
• activation of natural detoxication systems of organism
BLOOD RHEOLOGY CORRECTION
• reduction of blood viscosity
• increase of blood cells’ deforming
• reduction of cell conglomerates’ formation, vasodilatation
IMMUNOCORRECTION
• elimination of antigens, antibodies, circulating immune
complexes
• activation of immune system
• changing of immune response
INCREASE OF SENSITIVITY TO ENDOGENOUS AND DRUG
SUBSTANCES
18. • Efferent treatment methods are widely
used for restoration of disturbed
homeostasis. Particular importance in
functioning of organs and systems has a
constant composition of the liquid base of
body - tissue fluid and blood. Disturbance
of individual organs’ function will
inevitably entail changes in blood and
disturbance of physiological processes of
other organs and systems.
19. DETOXICATION
• Elimination of exo- and endotoxins
(med.preparations, chemical agents, Escherichia
coli endotoxin, inflammatory mediators, ferments,
hormones, products of free radical oxidation),
blood cells deplasming
• Increase of antioxidant defense factors activity
due to exit from the blood cells and decrease of
free radicals concentration, reduction of
regulatory substances number below the critical
level
• Break of existing vicious circles, improvement of
functional detoxification system - a manifestation
of “deblocking" procedures effect
20. Rheocorrection
• Decrease of blood viscosity,
increase of erythrocyte deformability,
transcapillary exchange,
improvement of microcirculation,
oxygen delivery to tissues,
normalization of tissue metabolism
21. Immunocorrection
• Activation of nonspecific resistance.
Increase of serum bactericidal activity,
content of complement, lysozyme,
functional activity of phagocytic
system with increase of phagocytic
index and phagocytic number of
neutrophils, normalization of
leukocytes’ spontaneous migration
22. SURGERY
• Application Before, Inter, and Post
surgery for the following indications:
Adequate inflammation.
Good healing.
Survival of flaps.
Decrease cardiovascular risk.
Decrease edema.
24. PSORIASIS
Plasmapheresis (PA) in psoriasis is indicated in the first place
to patients suffering from universal affection of the skin -
erythroderma, as well as exudative form of the
disease.Besides, PA should be applied as additional method
in case of insufficient efficiency of traditional therapy of
psoriasis, as well as in torpid course of the disease.
CRITERIA OF EFFICIENCY
• Reduction of infiltration in the zone of plaque and the
subsequent resolution of eruptions
• Increase of the quantity of T-lymphocytes
• Stimulation of phagocytizing activity of neutrophils
• Elimination of CIC from blood
26. PLASMAPHERESIS IN THE THERAPY
OF ATOPIC DERMATITIS
• Congenital breaches of reactions of cellular immunity in atopic
dermatitis are closely connected with blockade of beta-
adrenoreceptors. As a result of this, the processes of releasing of
mediators from fat cells and basophiles are intensified, which
brings about suppression of the function of Т-lymphocytes.
• The defect of Т-suppressors provokes elevated production of
IgE in response to antigenic stimulatio.
• Plasmapheresis (PA) breaks this vicious circle through
deblocking of beta-adrenoreceptors and mechanical removal of
excess of IgE.
27. INDICATIONS IN ATOPIC DERMATITIS
• Plasmapheresis is indicated as additional method
in combined therapy to patients with severe,
disseminated atopic dermatitis of long and torpid
evolution, including in its erythrodermic form.
CRITERIA OF EFFICIENCY
• Reduction of the level of IgE (after 48 hours there is registered
an increase of its concentration, but in repeated PA procedures
the level of IgE falls considerably).
• Reduction of the level of circulating immune complexes.
• Stabilization of the pathological process, cessation of the itch,
abrupt reduction of edema and hyperemia.
• Regression of acute manifestations of the disease, partial or
complete resorption of the infiltration.
29. PLASMAPHERESIS IN
THE THERAPY OF ROSACEA
• The etiology and pathogenesis of rosacea are
polydimensional. Due to this circumstance the range
of methods of therapy of this disease is wide.
However, the available data about the influence of
endogenic irritants, such as bradichinin, calikrein,
circulating immune complexes, different toxins, allow
to a certain extent to consider plasmapheresis ( PA)
as pathogenetic method of treatment of rosacea.
30. INDICATIONS IN ROSACEA
• Plasmapheresis is indicated in torpid forms of
the disease, resistant to traditional methods of
treatment.
CRITERIA OF EFFICIENCY
Regression of eruptions
Long-lasting remission
32. PLASMAPHERESIS IN THE THERAPY
OF FOCAL SCLERODERMA
• Special role in the pathogenesis of the disease is
played by autoimmune reactions
INDICATIONS
The success in the application of plasmapheresis
(PA) in this form of the disease as well as in case of
a systemic process is explaned by removal of
antibodies and inhibition of their syntheses
CRITERIA OF EFFICIENCY
Cessation of progression of the skin affections
Improvement of the mobility of the joints
34. PLASMAPHERESIS IN THE THERAPY OF
ACUTE EPIDERMAL NECROLYSIS
(LYELL’S SYNDROME)
• What plays a leading role in the pathogenesis of this disease is
the allergic reaction, which by its gravity yields only to anaphylactic
shock.
• Important role is played by immune mechanisms, in particular, the
cytotoxic action on the cells of the epidermis, accompanied by toxic
manifestation of idiosyncrasy on the part of epidermal cells to
different agents.
INDICATIONS
The application of the eliminating effect of plasmapheresis (PA)
depends on the etiological variant of the Lyell’s syndrome -
infectious, medicinal, toxic-allergic or idiopathic.
CRITERIA OF EFFICIENCY
Epithelization of the focci of affection
Controlling of the symptoms of intoxication
35. PHOTOS AFTER 3 SESSIONS OF
PLASMAPHERESIS IN NECROLISIS
POSTLIPO
36. GOLD STANDARD OF REJUVENATION
PROTOCOL
1 Membrane Plasmapheresis (detoxification, and removal of free
radicals) for the use of platelet-poor plasma.
2 Extraction for preparing platelet rich plasma the conventional
protocol.
3 Mixed with 80% of 20% of prp ppp to generate growth factors
(TGF-β1, EGF, FGF, IGF-I), and applied subdermal where required.
Physiological and aesthetic rejuvenation Scientifically proven
high standards of high-powered microscope and immunologic
markers stable.
REFERENCES
Micropartículas circulantes derivadas de Plaquetas. Su asociación con
diversasPatologías.
Dra. Norma de Bosch Universidad Central de Venezuela Facultad de Medicina Postgrado de
Hematología. Banco Municipal de Sangre Caracas. Venezuela 2011
41. What is removed from blood after
membrane plasma filtration?
Substance Pathogenic influence
lipoproteins of low and so-called “bad” cholesterol, which is responsible for
very low density atherosclerotic plaques formation
their excess is usually associated with lipid, i.e. fat
Triglycerides
metabolism
fibrinogen and its
thrombogenic factors
breakdown products
factor Villebranta, C1 and
substances accompanying damage of vessels’ inner lining in
C3 complement
components
various vasculitis, diabetes
connection of antibodies to the antigen, bacteria “fragments”
migrating in the body for a long time and settling on the
Immune complexes
kidney tissue, vessel walls, contributing to the formation of
autoimmune reactions
immunoglobulins, modified immunoglobulins, including autoantibodies,
including cryoglobulins, contributing to development of autoimmune diseases, damage
and antibodies of own tissues, obstruction of capillaries, etc.
fibronectin in excess contributes to cell adhesion
42. Prospective directions
• Today using a complex of
hemapheresis, quantum blood
treatment, ozone therapy, cascade
plasmapheresis methods is
considered to be prospective
43. UPDATES
• The use of autologous platelet-poor plasma (PPP)
dates from 80 in the U.S., by and bypass
machines as a byproduct of multicomponent
apheresis, separated the components of the
patient's blood and now employ through
membrane filters (NANOTECHNOLOGY) during
surgery as a hemostatic or adhesive gel, rich in
fibronectin, Von Willebrans factor, vitronectin,
thrombospondin and other adhesive proteins
