Low-volume discrete plasmapheresis in therapy of acute destructive lung and pleural diseases

Plasmapheresis with an exfusion volume of 1500-1600 ml has a pronounced detoxification effect in acute destructive lung and pleural diseases (ADLPDs) but can disturb volume balance and produce hypo- and dysproteinemia. The efficacy in pulmonary abscesses and gangrene was compared for standard discrete plasmapheresis (DPP, exfusion 1500-1600 ml) and low-volume DPP (LVDPP, exfusion 600-750 ml), which produces fewer volume-related complications. To increase the detoxification effect, LVDPP was combined with shortwave ultraviolet modification of erythrocytes to be reinfused (UME) in 29 patients or erythrocyte treatment with saline (ETS) in 21 patients or Hemodez (ETH) in 26 patients. The highest detoxification effect was observed for LVDPP-UME. The detoxification effect of LVDPP-ETH was comparable with that of DPP, and the effect of LVDPP-ETS was lower. LVDPP did not produce hypoproteinemia, while standard DPP aggravated it. LVDPP-UME and LVDPP-ETH normalized the proteinogram, while LVDPP-ETS did not improve the proteinogram nor aggravate dysproteinemia. LVDPP considerably decreased mortality and increased the rate of recovery with cicatrization of cavities. LVDPP-UME had the most pronounced effect in this respect, while the effect of LVDPP-ETS was lower. Thus, LVDPP-UME produced the best results in treating ADLPDs.