Double Filtration Plasmapheresis: An Effective Treatment of Cryoglobulinemia

Abstract

In cryoglobulinemic vasculitis, circulating immune complexes are deposited intravascularly, resulting in organ damage. Removal of these aggressive agents by means of therapeutic apheresis procedures improves the clinical status. Until recently, plasma exchange was the treatment of choice but the advent of selective methods has provided more versatile tools. Double filtration plasmapheresis (DFPP) can eliminate high-molecular-weight substances, mainly immunoglobulins and lipoproteins, while sparing the remainder of the plasma, which can then be restored to the patient without the need to infuse replacement solutions. This semi-selective method has been successfully employed to treat skin lesions caused by cryoglobulinemic vasculitis resistant to traditional therapy. By eliminating precipitating cryoglobulins, DFPP targets the pathogenic component of the vascular damage. Moreover, since it also removes hepatitis C virus particles, known to be the main cause of cryoglobulinemia, it is able to reduce the impact of the etiological agent of the vasculitis. Although DFPP has been regarded as a salvage therapeutic option for use in emergencies and confined to cases refractory to standard medical therapy, its role as an integrated, synergistic form of treatment should now be recognized.