The use of therapeutic apheresis in cardiovascular disease

O. Pignalosa, T. Infante, C. Napoli

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

SUMMARY: In the last few years, therapeutic apheresis (TA) has emerged as a valuable treatment option for certain life-threatening cardiovascular diseases (CVDs) and for all the cardiac dysfunctions caused by autoimmune or metabolic disorders. Besides the well-established indications for apheresis treatment, such as familial hypercholesterolaemia, hyperviscosity syndrome and thrombotic thrombocytopenic purpura (TTP), we discuss the novel approaches in the therapy of dilated cardiomyopathy, cardiac failure and some specific syndromes of severe dysfunction occurring after heart transplantation. The rationale for using apheresis in such patients is the contribution in immune modulation that this procedure can undoubtedly provide. The clinical course of TTP has dramatically changed, thanks to the introduction of therapeutic plasma exchange. Low-density lipoprotein apheresis has been extremely efficacious, safe and suitable for lowering cholesterol levels and can be used even for long-term treatment. In Waldenström macroglobulinaemia and other hyperviscosity syndromes, plasma exchange has demonstrated to be an efficient tool for reducing blood viscosity and the risk of a consequent cardiac dysfunction. However, TA may induce oxidative injury to erythrocytes, making these cells more prone to haemolysis and causing a significant reduction in their half-life. Ascorbate administration can be useful to lower the levels of hydrogen peroxide and proinflammatory mediators in patients undergoing apheresis. Further data are needed to support this benefit and to test other potential antioxidant therapies. Many of these therapeutic indications need further studies to be definitively approved, but preliminary data are encouraging.

Original languageEnglish
Pages (from-to)68-78
Number of pages11
JournalTransfusion Medicine
Volume24
Issue number2
DOIs
Publication statusPublished - 2014

Fingerprint

Blood Component Removal
Therapeutic Uses
Cardiovascular Diseases
Thrombotic Thrombocytopenic Purpura
Plasma Exchange
Therapeutics
Waldenstrom Macroglobulinemia
Blood Viscosity
Hyperlipoproteinemia Type II
Dilated Cardiomyopathy
Heart Transplantation
Hemolysis
LDL Lipoproteins
Hydrogen Peroxide
Half-Life
Heart Failure
Antioxidants
Erythrocytes
Cholesterol
Wounds and Injuries

Keywords

  • Cardiovascular diseases
  • Immunoadsorption
  • Therapeutic apheresis
  • Transplantation

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

The use of therapeutic apheresis in cardiovascular disease. / Pignalosa, O.; Infante, T.; Napoli, C.

In: Transfusion Medicine, Vol. 24, No. 2, 2014, p. 68-78.

Research output: Contribution to journalArticle

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