Doublefiltration – Selective and safe apheresis
If high-molecular plasma proteins are highly increased, they can have a pathogenic effect and lead to severe disease progression. Double filtration is a method of therapeutic apheresis that can quickly and specifically remove these plasma components in just two steps. In DFPP, the plasma is separated from the blood in the first step (first filtration). In the second filter, the Rheofilter ER-4000, triglycerides, immunoglobulin M, fibrinogen and other high-molecular proteins are specifically filtered out of the plasma (second filtration). The patient just receives his or her own “cleaned” blood back. No substitution of albumin is necessary.
DFPP in severe hypertriglyceridemia (SHTG)
Very high concentrations of triglycerides in the blood of more than 1,000 mg/dl (11.3 mmol/l) can lead to recurrent, severe pancreatitis. High-molecular lipoproteins with a very low density are particularly rich in triglycerides. If changes in diet and lifestyle as well as medication cannot lower triglycerides sufficiently and inflammation of the pancreas has to be treated repeatedly, regular outpatient use of DFPP can be considered as an option.
Selected indications for DFPP can be:
- Hypertriglyceridemia (e.g., in pancreatitis)
- Refsum’s disease
- Hyperviscosity syndrome (Waldenström’s disease, cryoglobulinemia)
DFPP — Easy to implement
The blood (red) is fed into the first filter, the Plasmaflo OP plasma separator, via a shunt or a peripheral puncture for outpatient apheresis treatment or a central access for treatment in hospital. There, the plasma (yellow) is separated from the cell-rich fraction of the blood. This plasma contains high-molecular plasma proteins such as immunoglobulin M and fibrinogen, but also triglycerides. These large molecules are now retained in the second filter, the Rheofilter ER-4000. The filtered plasma is then combined with the cell-rich fraction of the blood. The patient receives his or her own “cleaned” blood back (blue).
The entire treatment runs continuously for about two to three hours. Albumin or other plasma substitutes are not necessary. For optimum plasma flows, plasma separators with a particularly large surface area of 0.8 m² are used for apheresis.
How efficient is DFPP?
A survey of ten chronic high-risk patients in Germany with severe hypertriglyceridemia demonstrated the efficacy and tolerability of long-term DFPP. The absolute number of acute pancreatitis and cardiovascular complications was significantly reduced by 77% (Grupp et al., 2020).
What does DFPP remove?
DFPP with the Rheofilter ER-4000 efficiently and selectively removes triglycerides, large plasma proteins such as immunoglobulin M and fibrinogen as well as total cholesterol. Albumin remains almost unaffected.
How is DFPP reimbursed in Germany?
DFPP is reimbursed uniformly in german hospitals according to the additional charge ZE36 identical to plasmapheresis with OPS code 8-826.0*. The cost of nursing and medical care is also taken into account separately.
In patients with acute SHTG pancreatitis, the length of hospital stay could be significantly reduced by using DFPP (Chang et al., 2015).
For chronic outpatient therapy, DFPP can be billed as a health insurance benefit in justified cases on individual application.
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The following information is intended for healthcare professionals only.
The information in the section ‚products & therapies‘ is intended to provide explanatory, scientific, and evidence-based answers to medical questions about therapeutic apheresis.
This information does not constitute medical advice. The responsibility for patient care rests with the healthcare professional based on their professional licensure, experience, and knowledge of the patient.