[Pathophysiological aspects and clinical indications for plasma exchange treatment]

After a rather long initial period fraught with difficulties, plasma exchange has become an adjunct to the treatment of numerous diseases in medicine, such as hyperviscosity syndrome, where it alleviates disease symptoms, hemophilia due to inhibitors to clotting factor VIII, thrombotic thrombocytopenic purpura, rapidly progressing and Goodpasture glomerulonephritis, myasthenia gravis and Guillain Barre syndrome. As yet there are no formal indications for plasmapheresis, i.e. randomized placebo controlled studies are rare and proof of efficacy is often based on clinical criteria only. Therefore this treatment may be a transient means of removing noxious substances from plasma, giving way to more specific apheresis procedures such as plasma filtration, cascade filtration or immunoadsorption over charcoal or over solid-phase bound antibodies against the substance it is desired to remove. The present study presents the various plasmapheresis techniques, outlines the pathophysiological background to this treatment and adopts the now standard classification of indications into hematological, nephrological, neurological and miscellaneous indications. The English speaking reader will find an updated reference list of work published mainly in that language.