Importancia de la aféresis terapéutica en la especialidad de nefrología

The aims of therapeutic apheresis are: a) extraction and elimination from plasma of disease mediators or disease carrying media, b) replacement of deficient factors, and c) improvement of the function of the reticuloendothelial systems and certain inflammatory mediators. Together with Pharmacology and Surgery, therapeutic apheresis represents a treatment modality designed mainly for the treatment of specific diseases in which conventional therapy has not achieved the desired response. Plasma can be separated from blood cells by centrifugation or filtration. Plasma separation by centrifugation is performed by hematologists, and the aim is to separate and store plasma and the various blood components from healthy donors for subsequent use in recipients with coagulation disorders or other diseases requiring specific factors. Plasma separation by filtration is performed through high permeability membranes. The aim is to separate the cellular and non-cellular components of blood. The pores of the high permeability membranes allow the passage of plasma but prevent that of blood cells. Therapeutic apheresis is usually performed through plasma separation by filtration. Given the similarity between plasma separation with membranes and the technique of hemodialysis, the aim of the present article is to advocate the use of therapeutic apheresis in nephrology. We provide a detailed explanation of both techniques, based mainly on extracorporeal circulation and its management (vascular access, anticoagulation, safety measures of the techniques, purification monitors, knowledge of the various lines and filters) and complications, as well as the care of patients with distinct diseases leading to hemodynamic instability, currently highly frequent in patients under hemodialysis.