Der Nephrologe

, Volume 6, Issue 2, pp 149–154

Plasmapherese und Immunadsorption auf der Intensivstation

Leitthema

Zusammenfassung

In den letzten 40 Jahren haben sich die Technologie und die Indikationsstellung des therapeutischen Plasmaaustausches kontinuierlich weiterentwickelt. Mit zunehmender Inzidenz von Autoimmunerkrankungen, wegen mangelnder Therapieoptionen und auch aufgrund ökonomischer Überlegungen wurden immer selektivere Techniken des Plasmaaustausches entwickelt. Die Immunadsorption ermöglicht heute die spezifische extrakorporale Elimination pathogener Immunglobuline. Für den Einsatz der Plasmapherese und der Immunadsorption liegen zunehmend Daten für diverse Autoimmunerkrankungen auch und gerade bei kritisch kranken Patienten vor. Diese Evidenz stützt sich zum Teil auf Fallbeschreibungen und kleine Fallserien; randomisierte, kontrollierte Studien fehlen bisher bei vielen Krankheitsbildern. Dennoch werden die Plasmapherese und insbesondere die Immunadsorption zunehmend auch auf der Intensivstation eingesetzt, da sie eine große therapeutische Chance für kritisch kranke Patienten implizieren und in der Anwendung relativ sicher und nebenwirkungsarm sind, wenn eine ausreichende fachliche Expertise und ein adäquates Monitoring sichergestellt sind.

Schlüsselwörter

Plasmapherese Immunadsorption Intensivstation Extrakorporal Sepsis 

Plasmapheresis and immunoadsorption in the intensive care unit

Abstract

Over the last 40 years plasmapheresis technology and its indications for use have been continually evolving. With the growing incidence for autoimmune diseases, unsatisfactory therapeutic options, side-effects of drug therapy, economic relevance and apheresis, clinicians have been tending more towards selective plasmapheresis techniques through the use of immunoadsorption columns. Immunoadsorption is used to target specific disease-producing pathogens for removal during extracorporeal therapy. Evidence is accumulating for the use of plasmapheresis and immunoadsorption in several immune-mediated conditions in critically ill patients. The outlook for some emergencies continues to be desolate, however, and various therapies are used based on evidence from case reports and small case series even if randomized, controlled studies are still lacking for many diseases. The new therapies are relatively safe but careful monitoring is needed, because there is a potential for serious adverse events.

Keywords

Plasmapheresis Immunoadsorption Intensive care unit Extracorporeal Sepsis 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Sektion NephrologieMedizinische Universitätsklinik HeidelbergHeidelbergDeutschland

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