Doctor warns of risks of plasmapheresis

Haematologist Sotiris Koumas on Thursday warned against the use of plasmapheresis outside established therapeutic settings, saying the procedure can cause complications ranging from mild to serious and should only be performed at specialised centres.

Speaking to CNA amid public debate following the death of Giorgos Mazonakis and reports linking plasmapheresis with anti-ageing treatments, Koumas stressed that it was a specific medical procedure used to treat certain conditions.

Used in several medical specialties, including haematology and neurology, plasmapheresis involves removing and replacing a patient’s plasma, the liquid component of blood that carries substances including proteins, antibodies and clotting factors.

Koumas explained that in some conditions, pathological proteins, autoantibodies or other potentially harmful substances can accumulate in the plasma.

He cited thrombotic thrombocytopenic purpura as an example, saying plasmapheresis may be required and that early diagnosis and treatment can be crucial to a patient’s survival.

“The earlier you make the diagnosis, the earlier you start plasmapheresis – and we’re talking hours – the better the patient’s chances of survival,” he said.

Such treatment may require the cooperation of haematologists, nephrologists, intensive care specialists and surgeons, as well as specialised nursing staff, Koumas said.

He warned that complications can range from mild to particularly serious.

The placement of a catheter can cause injury or bleeding, while a catheter that remains in place for the duration of treatment can become infected or develop a clot.

During plasmapheresis, the patient’s blood passes through a specialised machine that separates and removes the plasma before returning the blood cells to the patient. Replacement fluid is administered to make up for the plasma that has been removed.

“This fluid may, depending on the indication and method, be plasma from donors,” Koumas said.

He explained that donor plasma, as a biological product, can cause allergic reactions requiring anything from simple anti-allergy medication to more significant medical intervention.

Patients may also experience a drop in blood pressure or electrolyte disturbances, which in some cases can lead to arrhythmia.

Koumas stressed that these were known risks that could be managed in an appropriate hospital environment.

“That is why plasmapheresis must be performed in specialised centres, for specific therapeutic indications,” he said.

Asked whether plasmapheresis was being used in Cyprus for anti-ageing purposes rather than to treat specific diseases, Koumas said he was not aware of such cases.

He referred the question to the competent authorities, saying they would be able to provide information on the purposes for which the procedure was being used and whether these fell within approved scientific protocols.

“I apply the therapeutic approach within the framework of the introductory protocol,” he said.

Regarding the regulatory framework governing centres offering such procedures in Cyprus, Koumas said the health ministry was the competent authority.

He said facilities and services were required to meet specific requirements to obtain a licence, but stressed that effective oversight of the services they provided was also necessary.

“Inspections must also be stepped up. And yes, everyone must be inspected,” he said.

Asked what he would say to someone seeking plasmapheresis solely for anti-ageing purposes, Koumas said this fell outside his area of expertise but cited the fundamental medical principle: “First, do no harm.”

“If you don’t know what you’re doing, it’s better not to intervene with an unwell patient, so as not to cause further harm,” he said.

Turning to prevention, Koumas said medicine could effectively address risk factors including high cholesterol, smoking and alcohol consumption.

“Doctors often say that prevention accounts for 50 per cent of treatment,” he said.

Koumas added that therapeutic plasmapheresis carried out in public hospitals in Cyprus had produced results “within the range of international success and failure rates”, stressing that, as with any medical treatment, “there were also failures”.