Double Filtration Plasmapheresis: An Effective Treatment of Cryoglobulinemia

  • Alfonso Ramunni
  • Paola Brescia


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.


Plasma Exchange Mixed Cryoglobulinemia Albumin Solution Secondary System Extracorporeal Circuit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ferri C, Zignego AL, Pileri SA (2002) Cryoglobulins. J Clin Pathol 55:4–13PubMedCrossRefGoogle Scholar
  2. 2.
    Gorevic PD, Frangione B (1991) Mixed cryoglobulinemia cross-reactive idiotypes: implication for relationship of MC to rheumatic and lymphoproliferative diseases. Semin Hematol 28:79–94PubMedGoogle Scholar
  3. 3.
    Cohen SG, Pittelkow MR, Su WPD (1991) Cutaneous manifestations of cryoglobulinemia: clinical and histopatologic study of seventy-two patients. J Am Acad Dermatol 25:21–27PubMedCrossRefGoogle Scholar
  4. 4.
    Tarantino A, Banfi G, Confalonieri R et al (1995) Long term predictors of survival in essential mixed cryoglobulinemic uremic nephritis. Kidney Int 47:618–623PubMedCrossRefGoogle Scholar
  5. 5.
    Savage COS, Harper L, Cockwell P et al (2000) Vasculitis. BMJ 320:1325–1328PubMedCrossRefGoogle Scholar
  6. 6.
    Dominguez JH, Sha E (2002) Apheresis in cryoglobulinemia complicating hepatitis C and other renal diseases. Ther Apher 6:69–76PubMedCrossRefGoogle Scholar
  7. 7.
    Vila AT, Barnadas MA, Ballarin J et al (2004) Cutaneous ulcers with type 1 cryoglobulinemia treated with plasmapheresis. Eur J Dermatol 14:186–189PubMedGoogle Scholar
  8. 8.
    Delaney VB, Fraley DS, Segal DP et al (1984) Plasmapheresis as sole therapy in a patient with essential mixed cryoglobulinemia. Am J Kidney Dis 4:75–77PubMedGoogle Scholar
  9. 9.
    Ramunni A, Lauletta G, Brescia P et al (2008) Double-filtration plasmapheresis in the treatment of leg ulcers in cryoglobulinemia. J Clin Apher 23:118–122PubMedCrossRefGoogle Scholar
  10. 10.
    Fujiwara K, Kaneko S, Kakumu S et al (2007) Double filtration plasmapheresis and interferon combination therapy for chronic hepatitis C patients with genotype 1 and high viral load. Hepatol Res 37:701–710PubMedCrossRefGoogle Scholar
  11. 11.
    Strunk J, Taborski U, Neeck G (2002) Essential cryoglobulinemic vasculitis with severe peripheral neuropathy and neurogenic muscolar atrophy- inducing remission by cascade filtration. Z Rheumatol 61:733–739PubMedCrossRefGoogle Scholar
  12. 12.
    Wood L, Jacobs P (1986) The effect of serial therapeutic plasmapheresis on platelet count, coagulation factors, plasma immunoglobulin, and complement levels. J Clin Apher 3:124–128PubMedCrossRefGoogle Scholar
  13. 13.
    Ramunni A, De Robertis F, Brescia P et al (2008) A case report of double filtration plasmapheresis in an acute episode of multiple sclerosis. Ther Apher Dial 12:250–254PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  1. 1.Division of Nephrology, Department of Internal and Public MedicineUniversity of BariBariItaly

Personalised recommendations