血液／血漿分離術之技術與發展

Blood/Plasma Apheresis Technologies and Development

張炎林(Yen-Lin Chang) ； 楊仲宇(Chung-Yu Yang) ； 黃慶成(Ching-Cheng Huang) ； 劉紹毅(Shaw-Yih Liou)

《中華民國血液淨化醫學會雜誌》 17卷1-2期 (2013/06) Pp. 16-46

摘要

血液／血漿分離術係將人體血液以體外循環方式連續導出，分離取出血液的部份特定成分，然後將剩餘成分流回人體身上。分離術可施用於捐血者也可施用於病人之治療。分離術施用於捐血者之目的是取出血液之部份特定成分，提供給缺乏特定成分的受血者，以達到治療受血者之目標。治療病人用的分離術，起因於醫療上已認知如果能夠快速連續分離取出病人血液中之部份特定成分，可以有效治療某些特定疾病。血液／血漿分離術依賴於儀器設備，儀器設備的進步也促進臨床治療效果。本文回顧血液／血漿分離術施用於捐血者與病人治療，以分離取出血液之特定成分；內容包含各種分離術之分離原理、各種分離術之名詞定義、治療性分離術之功效評估，以及目前廣泛使用於低密度脂蛋白（LDL）之去除療法。治療性LDL分離術現今可用的方法有6種：血漿交換、雙過濾程序、免疫吸附法、葡萄聚醣硫酸鹽纖維素吸附法、肝素誘導體外LDL沉澱法與血液灌洗法。該6種方法的技術原理、程序與臨床應用分別加以描述，也包括比較他們的特徵。

並列摘要

Blood/ plasma apheresis may be described as a process by which blood being removed from a subject is continuously separated into component parts, usually to allow a desired component (or components) to be retained while the remainder is returned to the subject. It can be applied to blood donors or to therapeutic patients. Application of apheresis technology to blood donors arose as part of a general movement toward blood component therapy, which in turn evolved from a wish to obtain a specific blood fraction to address a corresponding deficiency in recipients. Therapeutic apheresis arose from the perception that the ability to separate blood into its components rapidly and on line could permit reconfiguration of patient blood in ways that could favorably affect some disease processes. Apheresis depends on instrumentation, and many advances in the practice of apheresis have been linked to advances in instrumentation.This article gives an overview of methods and instruments used for donor collection or therapeutic applications to collect and/ or separate blood components by apheresis. The article contains principles of operation, definition of various apheresis procedures, evaluation of clinical efficacy, and the most current and commonly used systems for low- density lipoprotein (LDL) elimination. Today, there are six different LDL-apheresis systems available: plasma exchange, cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. Technical and clinical aspects of these six different LDL-apheresis methods are shown here. A comparison of features of different methods is also included.