History of Extracorporal hemocorrection
«Medicine is the art of addition and subtraction.
The subtraction of all that is excessive, and the addition of all that is missing.
And who might be the best at doing this – that and best doctor».
Hippocrates, the 5th century B.C.
- Origin of the application of Extracorporal hemocorrection methods
It is possible that the ancient "bloodletting" procedures were the prototypes of the modern Extracorporal hemocorrection methods. In the Middle Ages, bloodletting was a universal way of treating many diseases. It was used as an "apoplexy impact", for fever, for poisoning, etc.
There is certainly some rational thought for this method of treatment, even from the point of view of modern medical science.
n the first example – «the apoplexy impact» – which is a condition caused by a rise in arterial pressure, the doctor of that era simply reduced the volume of circulating blood until it reached a normal pressure. Now, to achieve this same result, we use other, «more civilized» methods. For example – diuretic preparations.
Using the «Bloodletting» method to treat a fever and various poisonings was also quite justified in that era. As we now know, both for fever and for poisonings, the weight of known pathological processes was defined by substances that were dissolved in the blood. Therefore the «Bloodletting» procedure achieved a lower concentration of the pathological substances that were dissolved in the blood, and thus achieved an improved condition.
However, despite the simplicity of this procedure, there were many negative side effects. For instance, along with the negative pathological substances, a number of the needed blood components, such as blood cells (erythrocytes, leukocytes, and trombocytes) are also removed.
Therefore, the evolution of an idea about the development of a way to selectively remove «excessive» components from blood is quite normal. Then there was an idea to remove a certain quantity of blood, and to «clear this blood» of certain pathological substances, and then return this blood to the vascular system.
However, the practical application of this idea was not possible until the beginning of the twentieth century.
- The first extracorporal hemocorrection operations
Experiments on animals
In 1902, Dr Hedon began experiments on cleansing and re-transfusion of autology erythrocutes in dogs and rabbits, by 1909 Dr Fleig had described a case of treating a patient with a uraemia by bloodletting with the subsequent return of the erythocytes cleansed in a salt solution.
However, the development of a new method «clarifications of blood» (or «clarification of an organism») from pathological substances, which is a plasmapheresis method, was first associated with the names Abel (USA) and Yourevich (Russia). The originator of the name «plasmapheresis», professor Abel deduced it by combining two concepts; plasma (a liquid part of blood) and the Greek apheresis (removal). Thus, plasmapheresis is a selective removal of plasma from an organism.
Between 1912 and 1914, a group under the direction of professor J. Abel in the Pharmacology Laboratory of Johns Hopkins Medical School in Baltimore, performed hemodialysis and plasmapheresis experiments on dogs. This work is well known all over the world (they are cited in all texts on hemodialysis or plasmapheresis). The results of these works were published in 4 papers [1, 2, 3, 4].
Unfortunately similar works by Russian scientists in this field, for a number of reasons, were much less known.
However, similar work was carried out in Russia at the same time. The eminent professor of the Army Medical College, head of the department of infectious diseases of the Army Medical College in (S-Pb), Vadim Aleksandrovich Yurevich, headed these works. V.A. Yurevich performed this research along with a member of the faculty, Mr N.K. Rozenberg. The results of the research of these scientists were published in an article «A question of cleansing blood outside of an organism and the vital stability of red blood cells», which was published in the «Russian Doctor» magazine, issue 18 of 1914 . The core of this article was the concept of active cleansing of an organism of excessive amounts of toxic substances by extracorporal (outside the body) processing of the blood (cleansing of the blood).
Processing of the blood («cleansing of blood») included the exfusion (removal) with the simultaneous injection of a physiological solution, centifugation at speeds of 1500 – 3000 rpm, removal of the plasma, tromocytes, and leukocytes, a 2 -3 fold cleansing of the uniform elements of the blood, adding a physiological solution of the appropriate volume, heating to 38 – 40о C and returning it to the organism. The process of modifying the blood cells was an attempt to to restore their damaged functions by any means, for example production of oxygen.
All of the experiments involving the Plamapheresys procedure were performed on rabbits. The first successful procedure of «cleansing of blood» - a plasmapheresis procedure - was performed on February 2 (15), 1913. In essence, it was the first example of centrifugal plasmaphersys performed in Russia. All of the rabbits underwent the experiment successfully. They maintained their appetites and there was no weight loss nor rise in temperature. The loss of erytrocytes was insignificant and all major organs continued to function well. The scientists of our modern era (professor V.I. Perveev - Siberian State University) have proven that blood cells are capable of surviving rotational speeds up to 2000 rpm «without serious consequences». The number of leukocytes and trombocytes quickly returned to normal, and often exceeded the norm. Surgical examination did not reveal any changes to the internal organs.
Unfortunately, it was impossible to continue these experiments. The First World War began, followed shortly by the Russian Revolution. Soon after the Revolution began, professor Yurevich was compelled to leave Russia. Little is know about his life thereafter, but it was apparently not possible for Dr Yurevich to continue his scientific research in the field of plasmapheresis. V.A. Yurevich died on February 26, 1963 in New York and he is buried in a Russian Orthodox cemetery in New Jersey.
I.P. Mihajlovsky proposed the use of plasmapheresis for medical purposes in 1925. His idea was based on removing a superfluous amount of plasma from an organ to study the physiological and pathological products that play a pathogenic role in the development of disease and its complications.
Unfortunately however, the technical approaches developed by Yurevich and Abel in their work with animals in the early part of the 20th century were long forgotten. Only during the last 30 years have scientists returned to these methods of treatment of disease in people.
The first extracorporal hemocorrection procedures on people
In 1944, Waldenstrom, while describing a case of Macroglobulinemia with symptoms of increased blood viscosity (Waldenstrom illness), returned to the process of reinfusion of autologious erytrocytes in the patient, with the purpose of removing plasma along with the surplus pathological protein contained in it.
In 1955, Waldenstrom and Willert performed effective plasmapheresis procedures on a patient with Macroglobulineia, having noted a reduction in the level of Macroglobulin in the blood, and by 1963 this plasmapheresis procedure was used successfully in several patients with Macroglobulinemia and symptoms of increased blood viscosity.
In our country the medical plasmapheresis procedures have been used since 1964 when R.A. Mokeeva observed symptoms of increased blood viscosity contained in vessels, along with Macroglobulineia of Valdenstrem (Waldenstrom ), and later - with other paraproteinemical hemoblastoses.
The period of active application of plasmapheresis as a method of additional intensive therapy began in many countries since 70’s. By 1980, England was performing approximately 1000 plasmapheresis procedures a year. The past 70 years saw 6,200 procedures in France and in the USA in 1981, 50,000 procedures of medical plasmapheresis were performed.
During these years, the centrifuge was used for the division of blood. However, after 60 years of procedures, the special separator of blood cells was developed in the USA, allowing the automation of the division of blood into its components.
In 1976 a new process was developed that enabled the plasma to be filtered through semi tight membranes constructed of polyvinyl diacetals cellolose – called Lavsan Filters – a technology of membrane plasmapheresis. These filters contain various diameter openings that will pass some molecules but block larger molecules and blood cells.
Another method of extracorporal hemocorrection is the use of sorption technologies. The most common of these methods is the hemosorption method. Hemosorption is based on perfusion of the blood using coal or other sorbents allowing the fluid to sorb on the surface and therefore remove toxic substances from the bloodstream. The basic purpose of the use of hemosorption is detoxification (that is cleansing of the blood or cleansing an organism of toxic substances).
These technologies were used abroad when K. Hagstrom in 1966 and M. Demyttenaere et. al. in 1967 described the embolia of various bodies in particles of coal during hemosorption. After this time, the interest in these methods diminished for many years.
- Newest history of the Extracorporal Hemocorrectiom
In recent times, with further development of this area of medical science, 3 basic stages have been identified.
1. Toward the end of the 1970's and the 1980's, a majority of medical practitioners were aware of several methods of extracorporal hemocorrection such as hemosorption, plasmapheresis, and methods of wave processing of blood (an ultra-violet irradiation of blood and, a short time later laser irradiation of blood). This marked the introduction of these procedures into clinical practice and the first impressive successes by a host of doctors in nearly all specialties. A prominent feature of this period was the frequent use of hemocorrection techniques on a wide spectrum of diseases without taking into account other symptoms. Thus, the majority of doctors using these procedures in their medical practice had only an approximate picture of the results of their actions.
2. The beginning of the 1990's was the «first stage of negative consequences». The majority of recent supporters of methods of extracorporal hemocorrection came to realize their low efficiency rate and the high frequency of complications. The disappointment had arrived. In the West during this period, there was a lot of research concerning the efficiency of the plasmspheres methods. It is important to point out that the research that was performed concerned the efficiency of a method of «plasmaexchange». The results of recent research has shown that the given method of treatment was effective only on a limited number of diseases. Because of this, further development of extracorporal hemocorrection in the West has been considerably slowed. During this period in Russia, in a majority of medical centers, there has also been a decrease of interest in the problems of extracorporal hemocorrection.
3. From the mid 1990's to the present time there has been a continuation of research into the efficiency of hemocorrection carried out in some medical centers in Russia. This research was carried out with the following basic directions:
- the study of the types of influence of the methods of extracorporal hemocorrection on those, or other chains of patogenesis of various diseases
- a careful estimation of the indications and contra-indications that were realized
- the development of new selective and semi selective techniques and complex programs for the application of methods of extracorporal hemocorrection for specific pathological processes
The result of the performed research was the creation of new extracorporal hemocorrection technologies - technologies of the 1st, 2nd, and 3rd generation. ( the 1st generation is simple, non selective technologies such as plasmapheresis and hemosorption: the 2nd generation is selective and semi selective technologies such as cryoplasmapheresis, cryoplasmasorption, immunosorption, double filtrational plasmapheresisis, thermoplasmasorption, etc.: and the 3rd generation is a complex program of modules of extracorporal hemocorrection for solving certain broad problems in the correction of the pathological processes in which methods of the 1st generation also play a roll. This allows for the consideration of the initial substrata and their further modification).
The currently developed technologies of extracorporal hemocorrection are now successfully used as complex programs in the treatment of a wide range of diseases, resulting in the solution of problems that were impossible with the use of traditional medicamentous therapy or those methods of treatment that resulted in significant difficulties and the danger of damaging an organism of the patient. The reviews of the modern technology of extracorporal hemocorrection and the possibility of using this technology in the treatment of various diseases are considered on other pages of this web-site.
- Abel J.J., Rowntree L.G., Turner B.B.On the removal of diffusible substances from the circulating blood by means of dialysis // Trans. Ass. Am. Physicians. – 1913. – Vol.28. – P.51.
- Abel J.J., Rowntree L.G., Turner B.B. On the removal of diffusible substances from the circulating blood living animals by dialysis // J. Pharmacol. Exp. Ther. – 1913-1914. – Vol.5 – P.275.
- Abel J.J., Rowntree L.G., Turner B.B. Some constituents of the blood // J. Pharmacol. Exp. Ther. – 1913 – 1914. – Vol.5 – P.611.
- Abel J.J., Rowntree L.G., Turner B.B. Plasma removal with return of corpuscles (plasmapheresis) // J. Pharmacol. Exp. Ther. – 1913 – 1914. – Vol.5 – P.625.
- Yurevich V.A., Rozenberg N.K. A question of cleansing blood outside of an organism and the vital stability of red blood cells// Russian Doctor. – 1914. – Vol.13, №18. – P. 637 – 639.
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