Plasmosorption

Plasma sorption is carried out by perfusion of plasma through a sorbent. The procedure can be carried out in a continuous mode, and then the column with the sorbent is placed in the extracorporeal circuit.

In intermittent blood fractionation, the obtained plasma is perfused through the sorbent in recirculation mode using a pump. The plasma, purified from waste, is intravenously reinfused into the patient. The detoxifying column can contain from 100 to 400 ml of sorbent.

Plasmasorption is considered sufficient with perfusion of 1.5-2 VCP through 200 ml of sorbent. Monitoring of detoxification efficiency is performed by calculating clearance and elimination of the substance under study.

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Mechanism of action

Plasma sorption aims to remove circulating large- and medium-molecular toxic substances. When plasma is perfused through a sorbent, toxic metabolites are fixed on its surface and in the pores. Low plasma viscosity and the absence of formed elements explain the greater efficiency of removing exogenous toxic substances during plasma sorption compared to GS.

Expected effect of plasma sorption

The removal of large and medium-molecular toxic metabolites from the body leads to an improvement in the general condition of the patient and creates favorable conditions for the functioning of all body systems.

Plasmasorption in combination with plasmapheresis and plasmodialsis promotes detoxification of the body from a wide range of toxic substances that differ significantly in their physical and chemical properties and molecular weight. Complex plasma detoxification has a beneficial effect on the function of all vital organs and systems of the patient.

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Plasma methods of detoxification of the body in acute endotoxicosis

Equipment	The following devices are used to separate blood into formed elements of the blood and plasma: a) for centrifugal fractionation ; b) when performing membrane fractionation, plasma filters and an “artificial kidney” device are used; for intermittent (discrete) fractionation, a centrifuge is used . The patient’s blood (300-500 ml) is collected in special bottles or polyethylene bags with an anticoagulant - sodium heparin, glugicir, etc. Then, using a centrifuge (rotor speed 1800-2500 rpm), the blood is separated into two components - a cellular suspension in the form of a sediment and plasma (supernatant liquid). Toxic metabolites are concentrated mainly in the plasma . A significantly smaller part of them is on the surface of erythrocytes. Erythrocytes can be washed from toxic substances by dilution in a physiological solution or by perfusion through a sorbent . sorbents are used for plasma sorption
Highway system	In accordance with the procedure methodology, a set of lines intended for a given separator is used.
Vascular access	Central vein
Preliminary preparation	Before starting the procedure of removing plasma from the patient's body (plasmapheresis), it is recommended to perform an intravenous infusion of protein preparations, for example, 200 ml of plasma or colloids. If the hematocrit is 45% or higher, preliminary hemodilution is mandatory. The hematocrit in the range of 35-40% should be considered optimal. Depending on the indicators of the blood coagulation system, general or regional heparinization of the patient is carried out. When performing the procedure using the discrete option, the anticoagulant is contained in special plastic bags, which does not require heparinization of the patient.
Blood perfusion method	During the continuous separation procedure, the patient's blood is fed through a system of lines using a perfusion pump into a fractionating (separating) device - a centrifuge or plasma filter, from where it is discharged through two lines, one of which contains plasma and the other - a cellular suspension. The extracorporeal circuit is closed by a connecting line through which formed elements of the blood are introduced into one of the patient's veins. The isolated plasma can be detoxified using a sorbent (plasma sorption) and returned intravenously to the patient. The isolated toxic plasma can be removed during plasmapheresis, followed by its replacement with protein solutions. During intermittent separation, the patient's blood is collected in special plastic containers containing an anticoagulant, and then separated into two fractions by centrifugation - formed elements of the blood and plasma. Using a special squeezing device, the plasma is removed from the container, followed by its replacement with an equal volume of isotonic sodium solution. chloride Diluted formed elements of blood are returned intravenously to the patient The isolated plasma can be replaced with protein preparations or detoxified by plasma sorption and then injected intravenously into the patient
Blood and plasma perfusion volume	When performing a plasmapheresis procedure, the volume of blood perfusion determines the hematocrit number. To achieve a detoxifying effect, on average, 800-2500 ml of plasma is replaced. When performing a plasmadialysis or plasmasorption procedure, 1.5-2 VCP are perfused through a detoxifying device.
Recommended modes	During centrifugal blood separation, the rotor speed is 1800-2300 rpm1 During plasmadialysis or plasmasorption procedures, the plasma flow rate in the extracorporeal circuit depends on the volume of plasma obtained during blood separation.
Indications for use	Plasmapheresis toxemia with large-molecular (myoglobin) or protein-bound (bilirubin) substances, fibrinolytic bleeding against the background of intoxication In these cases, the patient's plasma should be replaced with fresh frozen donor plasma Plasma sorption intoxication with medium- and large-molecular toxic metabolites Used in addition to plasmapheresis to enhance the detoxification effect The use of plasma sorption as an independent procedure is inappropriate Preference should be given to GS - an economically cheaper procedure, although the amount of clearance and elimination of toxic metabolites with plasma sorption is higher than with GS
Contraindications	Hypoproteinemia (total protein less than 40 g/l), acute cardiovascular failure (BP below 80/40 mm Hg), risk of bleeding associated with heparinization of the patient, intolerance to foreign protein
Complications	When performing plasmapheresis, plasmadialysis, plasmasorption procedures, the following complications are possible: acute cardiovascular failure a) rapid blood exfusion, especially with a “complicated” extracorporeal system (plasma filter, dialyzer / sorbent / line) filled with the patient’s blood and plasma b) due to hypocalcemia with intravenous administration of excess sodium citrate as an anticoagulant for anaphylactic shock
Blood perfusion rate	Depends on the capacity of the separating device