The authors analyse the efficacy of extracorporeal heparin precipitation of plasma proteins (selective plasmapheresis) in patients with immune complex pathology. The method lies in extracorporeal precipitation at +4 degrees C of fibronectin, cryofibrinogen and other macromolecular complexes with the aid of heparin, followed by plasma return to the patient. The method was applied to 39 patients. Hemorrhagic microthrombovasculitis was diagnosed in 7, vasculitis paralleled by hepatosplenomegaly of unclear genesis in 1, generalized vasculitis with marked systemic manifestations in 1, immune complex vasculitis complicated by recurrent polychondritis in 1, chronic active hepatitis associated with immune complex vasculitis in 1, rheumatoid arthritis in 8, systemic lupus erythematosus in 4, spleen lymphoma and Sj?gren's syndrome in 1, idiopathic amyloidosis in 2, multiple sclerosis in 10 patients. Altogether 309 sessions of selective plasmaphapheresis were carried out. The time course of the clinical and laboratory criteria of the disease activity were studied before and after each plasmapheresis session. It was ascertained that the method is highly effective in the treatment of hemorrhagic vasculitis. It is mostly used if conventional therapy with heparin, cryoplasm, and deaggregating agents appears abortive. Apparently, it is the only method that may rapidly arrest the abdominal syndrome associated with hemorrhagic vasculitis. The possibility and advisability of the use of chronic plasmapheresis are discussed. Application of the method to the treatment of rheumatoid arthritis permits reducing the dose of steroid hormones, thereby not stimulating the disease activity. The method is the therapy of choice in different diseases associated with polyvalent allergy. In amyloidosis and multiple sclerosis, the method efficacy is questionable.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent Adult