[Review. The status of plasmapheresis and apheresis]

The paper surveys the technical and clinical development of plasmaexchange therapy. Until today there is no agreement on a unique treatment protocol, the variation ranges from 3-4 treatments in multiple sclerosis to biweekly chronic treatment in hypercholesterolaemia. An exchange volume of 1-1.5 of the plasma volume is recommended. Despite occasional complications, mostly due to replacement fluid, the method is regarded as safe. The first clinical application dates back to 1952, when Adams reported on the treatment of hyperviscosity syndrome. With rheumatoid arthritis plasmaexchange therapy of immunological mediated diseases started in 1963. In the following years a lot of enthusiastic case reports caused a general therapeutic optimism which was to be corrected by controlled trials. There is no proven benefit of plasmapheresis in rheumatoid arthritis and rapid glomerulonephritis for instance. For lymphoplasmapheresis in rheumatoid arthritis and for plasmapheresis in multiple sclerosis and renal graft rejection the results are contradictive. The paper discusses the different indications for apheresis therapy including hematologic disorders to be treated with plasmapheresis or cytapheresis.