Rheopheresis

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The Rheopheresis is a method for extracorporeal blood purification (apheresis), which for the treatment of disturbances of the microcirculation was developed. “Rheopheresis” is made up of the terms rheology and apheresis : rheology deals with the blood flow properties. Apheresis generally refers to the separation of certain components from the blood. The procedure was developed in the University Clinic in Cologne.

In the process, a certain spectrum of high molecular weight substances is filtered out of the blood plasma . These include fibrinogen , alpha-2 macroglobulin, LDL cholesterol , Von Willebrand factor and IgM . This causes a lowering of blood and plasma viscosity as well as the aggregation of erythrocytes. This improves blood flow and microcirculation, i.e. the exchange of substances between the smallest vessels and the surrounding tissue.

Areas of application

Age-related macular degeneration

Rheopheresis is used to treat the so-called “dry” form of age-related macular degeneration (AMD) and diabetic retinal disease. In a study by the University Eye Clinic in Cologne, a significant but time-limited improvement in vision compared to a control group was found, which was confirmed in an American study according to the Cologne clinic. A recent study by the University Eye Clinic Frankfurt a. M. showed the effectiveness of rheopheresis in 43 patients (22 rheopheresis, 21 control group). At the endpoint 7.5 months after inclusion in the study, eyesight had improved on average in the rheopheresis group and worsened in the control group. There was a statistically significant mean difference in vision (0.95 ETDRS lines, p = 0.01).

A final assessment of the procedure for treating AMD is not yet possible.

Sudden hearing loss

The effectiveness of the method for the treatment of sudden hearing loss was shown in a controlled, randomized, multicenter clinical study carried out in Germany on 240 patients in comparison to standard therapy. The patients were randomly divided into two groups: one group received two rheopheresis treatments within three days, the control group received standard therapy according to the current guidelines of the Society for ENT Medicine, consisting of methylprednisolone (250 mg iv for three days, subsequently oral dose reduction) or infusion therapy (500 mL 6% HES + 600 mg pentoxifylline per day) for a total of ten days each. Rheopheresis was found to be equally effective compared to the standard therapies investigated (p <0.001). In a further retrospective study, rheopheresis was able to achieve a significant improvement in hearing in patients with recurrent acute hearing loss who proved to be refractory to standard infusion therapy.

Other areas of application

The method is also used in individual cases for disorders of the microcirculation in chronically progressive diseases such as ischemic diabetic foot or peripheral arterial occlusive disease (PAD).

Individual evidence

  1. ↑ Brunner R, Widder RA, Borberg H: Use of extracorporeal treatment methods for selected eye diseases . In: Ophthalmologist . 96, 1999, pp. 679-682. PMID 10552163 .
  2. ↑ Kirschkamp T, Schmid-Schönbein H , Weinberger A, Smeets R: Effects of fibrinogen and alpha2-macroglobulin and their apheretic elimination on general blood rheology and rheological characteristics of red blood cell aggregates. . In: Ther Apher Dial. . 12, 2008, pp. 360-367. PMID 18937718 .
  3. ↑ Brunner R, Widder RA, Walter P, Luke C, Godehardt E, Bartz-Schmidt KU, Heimann K, Borberg H: Influence of membrane differential filtration on the natural course of age-related macular degeneration: a randomized trial. . In: Retina. . 20, 2000, pp. 483-491. PMID 11039423 .
  4. ↑ Pulido JS: Multicenter prospective, randomized, double-masked, placebo-controlled study of Rheopheresis to treat nonexudative age-related macular degeneration: interim analysis. . In: Trans Am Ophthalmol Soc. . 100, 2002, pp. 85-106. PMID 12545682 .
  5. ↑ Koss MJ, Kurz P, Tsobanelis T, Lehmacher W, Fassbender C, Klingel R, Koch FH: Prospective, randomized, controlled clinical study evaluating the efficacy of Rheopheresis for dry age-related macular degeneration: Dry AMD treatment with Rheopheresis Trial-ART . . In: Graefes Arch Clin Exp Ophthalmol. . 247, 2009, pp. 1297-1306. PMID 19629514 .
  6. ↑ Opinion of the working group Clinical questions of the Pro Retina: Rheopheresis for the treatment of age-dependent macular degeneration ( Memento of the original from October 30, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.pro-retina.de
  7. ↑ Mösges R, Köberlein J, Heibges A, Erdtracht B, Klingel R, Lehmacher W: Rheopheresis for idiopathic sudden hearing loss: results from a large prospective, multicenter, randomized, controlled clinical trial. . In: Eur Arch Otorhinolaryngol. . 266, 2009, pp. 943-953. PMID 18923838 .
  8. ↑ Uygun-Kiehne S, Straube R, Heibges A, Klingel R, Davids H: Rheopheresis in the case of recurrent sudden hearing loss - therapy option for patients after unsuccessful infusion therapy. . In: ENT. . Epub, in press. 2010. PMID 20182682 .
  9. ↑ Richter WO, Schneidewind JM, Ramlow W, Jahn P, Jung N, Nielebock E, Tachezy H, Eulitz K, Koll R, Klinkmann J: Extracorporeal fibrinogen adsorption - efficacy, selectivity and safety in healthy subjects and patients with foot ulcers. . In: Transfus Apher Sci. . 26, 2002, pp. 15-27. PMID 11931374 .
  10. ↑ Klingel R, Mumme C, Faßbender T, Himmelsbach F, Altes U, Lotz J, Pohlmann T, Beyer J, Küstner E: Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial. . In: Ther Apher Dial. . 7, 2003, pp. 444-455. PMID 12887730 .
  11. ↑ Klingel R, Erdtracht B, Gauss V, Piazolo A, Mausfeld-Lafdhiya P, Diehm C: Rheopheresis in patients with critical limb ischemia - results of an open label prospective pilot trial. . In: Ther Apher Dial. . 9, 2005, pp. 473-481. PMID 16354279 .

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