EUROMEDICAHanover3-4 Juni 2010 |
Advanced methods of diagnosis,
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European Academy of Natural Sciences, HanoverEuropean Scientific Society, HanoverBerliner Medizinischen Gesellschaft, Berlin |
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| G.V. Serdiuk A.P. Momot A.E. Dorokhov E.A. Dorokhov |
THE ANTIPHOSPHOLIPID SYNDROME: EFFECTIVE THERAPY BY THE DISCRETE PLASMAPHERESIS |
| Altai department of Hematologic Scientific Center of Russian Medical Sciences Academy, Altai State Medical University, Barnaul, Russia |
It is well known that antiphospholipid syndrome (APS) and lupus anticoagulants (LA) lead to the development of polythrombotic syndrome, disturbances of blood microcirculation resulting during pregnancy in miscarriages. Under our observation there were 245 patients: 129 women with persistent pregnancy and 116 patients of polythrymbotic syndrome.
For successful therapy of APS it is necessary to eliminate LA from blood and liquid mediums of an organism and to prevent new increase to LA after their elimination. To eliminate LA from blood we used the elementary method of discrete plasmapheresis (DPA). DPA should not be identified with the wide-spread method of plasmaexchange when a large volume of plasma is removed off momentarily, and the volume of circulating blood is substituted by donor plasma or other protein liquids. In comparison with plasmaexchange, DPA method makes it possible to remove a small volume of about 300-600 ml of plasma daily 5 days a week. As a rule salt isotonic liquid is used for substitution. From 3 to 6 liters of plasma are removed during 2 or 3 weeks. In this case we successfully eliminate APL and at the same time avoid complications characteristic for plasmaexchange, electrolytic and protein complications, dangerous immune reactions, ricochet increase of LA level, hemodinamic disorders, etc. A basic therapy DPA we also include the low molecular heparin s/c injections in doses of 7500U anti-Xa per day, and aspirin in dose 60-100 mg/day.
Thus we consider that for treatment of APS with of polythrymbotic syndrome and miscarriage LA is necessary to eliminate LA from blood using the method of DPA.
The combination of low molecular heparin with aspirin is mostly effective for preventing new increase of LA after their elimination ensures a normal course of pregnancy in women with APS with a normal delivery and normal development of their babies.