DFサーモ(加温式リサーキュレーション法)(<特集>アフェレシス療法における新しいmodality) Double-Filtration Plasmapheresis with Thermo-Mode
In order to improve the separation property in a plasma fractionator that was used in Double-filtration plasmapheresis (DFPP), DF Thermo was newly introduced as one form of the modified DFPP. In the DF Thermo, membrane plasma fractionation was maintained at 42℃ by a heater to avoid increasing plasma viscosity induced by aggregation of the globulin fractions around 30℃ in the conventional DFPP treatment. Recirculation of the retentive plasma of the plasma fractionator to the filtrated line of the plasma separator was introduced to accumulate pathogenic globulins related to symptoms with no supplementation fluid like albumin solution. An in vitro experimental study was carried out to clarify the effect of the temperature on separative property among albumin and some kinds of globulins in a plasma fractionator, Evaflux 5A (Kuraray Medical Co., Ltd.). With the decrease in the temperature, increasing transmembrane pressure (TMP) was observed and a decrease the separative property due to increasing membrane fouling because of protein plugging of the membrane. In a clinical study, an ASO patient with non-hyperlipidemia received ten DF-Thermo treatments. As a result, the levels of LDL-C, IgM and Fibrinogen and the patient's blood and plasma viscosity were significantly decreased, and the lower leg temperature of the patient improved fairly well after the treatments. The warmer temperature of the legs was maintained for four months after the start of the treatment. Rebound phenomena in several proteins, on the other hand, were observed after the treatments. The DF Thermo therapy, therefore, is useful for ASO patients with non-hyperlipidemia. DF Thermo is effective for improving QOL of the patients with severe ASO who have had difficulty in treatment with conventional therapies.