Access in therapeutic apheresis.

Various modes may be used to perform apheresis, such as plasma exchange, plasmapheresis, immunoadsorption, and blood perfusion. The vascular access used for acute procedures may be sufficiently supplied by two peripheral veins or catheters placed in the femoral vein or the right internal jugular vein. For chronic treatment it might be necessary to place an arteriovenous fistula or graft.

Apheresis as therapy for patients with severe sepsis and multiorgan dysfunction syndrome.

Progressive multiorgan dysfunction syndrome may occur in the course of sepsis and septic shock as well as after various intoxications, pancreatitis, crush injuries, and major surgery. Despite conventional intensive care therapies, the prognosis in these patients is still poor. Apheresis, which uses more selective adsorption techniques, can lower the extent of toxins and cytokines in blood.

The presence of superantigens and complex host responses in severe sepsis may need a broad therapeutic approach.

Patients with sepsis can progress into septic shock, disseminated intravascular coagulation, and multiorgan dysfunction syndrome. Various materials secreted by or released from microorganisms such as bacteria initiate these processes. In some bacteria, certain antigens and toxins may cause a 100-fold greater or supernormal activation of monocytes and T lymphocytes, leading to activation of the cascade systems in the host.