Immunomodulation: bioengineering aspects

Plasmapheresis is generally recognized as a "black box" therapy. Factors effecting the immunomodulating influence of plasmapheresis and their impact on the clinical results include the disease state and stage, associated drug and medical therapies, and the methodology of plasmapheresis. The immunomodulating influence of the methodology of plasmapheresis, including duration of treatment, frequency of treatment, equipment type, materials choice, anticoagulant choice, and volume replacement versus selective removal, has a profound impact on the clinical results. Limitations in the design of controlled trials emphasize the importance of assessing the events occurring within and as a result of the individual black box utilized in plasmapheresis therapy. The analysis and understanding of the immunomodulating influences of the "black box" will prove to be very valuable in the development of better technologies for patient care.