DFPP療法における安全性とその留意点(<特集>アフェレシスにおけるセイフティーマネジメント)  [in Japanese] Safety Management of the DFPP Treatment  [in Japanese]

Double-filtration plasmapheresis (DFPP) has been widely used clinically as apheresis therapy for various autoimmune diseases, blood-group-incompatible renal transplantation, familial hypercholesterolemia, arteriosclerosis obliterans, etc. DFPP is procedurally complicated, as compared to hemodialysis, because it is designed to separate plasma components in two stages. A firm knowledge and fixed technique are required for safe execution of the treatment. Unless the albumin concentration in the substitute fluid is adequate, for instance, there is the risk of hypotension and cardiac overload, due to a decrease of the colloid osmotic pressure. Unless the amount of substitute fluid handled is adequate, efficient removal of pathogenic substances cannot be expected. The method of administering anticoagulants also needs to be altered according to the treatment indication. It is important to establish proper treatment conditions tailored to individual patients. This article describes the importance of a control and monitoring system as safety management of the apparatus and the establishment of proper treatment conditions (substitute fluid, anticoagulants, etc.) for the safety of the staff involved with the treatment.