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Page 8 of 11 Yaroustovsky et al. Vessel Plus 2019;3:9 I http://dx.doi.org/10.20517/2574-1209.2019.02

EC-50W) on hematological and rheological indications (hemoglobin, leukocytes, platelets, fibrinogen,
thrombin-antithrombin complex, PAI-1, homocysteine) in the patients with familial hypercholesterolemia.
It was shown, that regardless of the technology used apheresis therapy hematological and hemostatic
[44]
parameters are affected differently, but still remain within the physiological intervals . This was also proved
by our observations, as we didn’t note cases with bleedings or thrombosis.

Probably, changes in hematological parameters, decrease of fibrinogen, coagulation factors and antithrombin
levels can be also partially associated with some moderate dilution. Taking into account differences of
treatment techniques at the stage of the extracorporeal circuit volume return, we noted more expressed
changes of these indications immediately after H.E.L.P.-apheresis. The explanation is that approximately,
1.2-1.5 L of saline solution is necessary for returning maximum blood components from the circuit after
H.E.L.P.-apheresis. On the other hand, decrease of fibrinogen concentration, INR and antithrombin level
can be associated with consumption as a result of procoagulant activation of the blood in contact with the
artificial circuit surface. Procoagulant activity is less advanced during cascade lipid-filtration.

Decrease of ESR is associated with reduction of lipid and fibrinogen concentration. The wide variation of
ESR in the context of H.E.L.P.-apheresis can be associated with higher residual activity of heparin in the
blood of the patient, the indirect evidence of which is elevated ESR.

The sets for measure the level of prothrombin time (INR) (HemosIL, RecombiPlastin 2G, ACL-TOP) include
calcium chloride polybrene, which has the capacity to inhibit not more than 1 U/mL dose of heparin.
For further studies we plan to estimate the level of heparin anti-Xa activity at different treatment stages.
Multidirectional changes of the WBC amount are more likely to be associated with the small randomization
and with individual body reactivity of the patients. This reaction is a physiological response to the procedure.
Statistically significant changes of hematological parameters after procedures were within or on the border
of reference intervals. Taking into account the slight dynamics differences of the analytes measured between
the sessions, the treatment is recommended to be individually choice to each patient’s condition [38,45] .

Lipid apheresis sessions frequency depends on the response to the therapy and lipidemia level (LDL, Lp(a)).
The decreased level of lipids begins to increase gradually after the apheresis treatment. The “growth” degree
is defined by catabolism rate and eliminated particles volume, as well as synthesis rate of these molecules.
Given the cholesterol synthesis pool (10-14 days), a question occurs, whether it is necessary to perform
program extracorporeal therapies, i.e., repeated sessions once per 2-3 weeks for a long period of time [32,46] .
To complete one of the tasks in our study - provide gradual decrease of atherogenic cholesterol baseline to
the target level - the sessions were performed once per 3-4 weeks along with pharmacological lipid-lowering
therapies and diets. Though the researchers mainly point out the advisable interval of 2 weeks between the
sessions, a number of authors show 3-4 weeks interval efficiency, and it correlates with our findings [25,30,37] .

The lipid apheresis therapy was safe and effective. In general, patients had a high appreciation, the sessions
proved to be safe and well-tolerated. Types and rates of side effects of lipid apheresis treatment are described
[51]
by different authors and in the registry of World Apheresis Association [47-50] . Heigl et al. (2015) studied
safety during 6 years and noted good tolerance to different techniques of lipid apheresis. As a whole,
[51]
according to the results of Heigl et al. (2015), side effects were not more than 1.1% (vascular issues,
[48]
technical issues). The study of Borberg et al. (2009) on lipid apheresis safety evaluation with more than
2,500,000 sessions registered in the world, confirm the general assessment of a small number of slight and
moderately expressed side effects - 3.3%. The issues, described by him, are problems of vascular access,
hypotension at the connection stage, allergic reactions, bruising after puncture and technical issues.

[52]
Even in the ‘90s Geiss et al. found out, that membrane cascade filtration is an effective method for decrease
of elevated concentrations of atherogenic lipoproteins. And the concomitant loss of other macromolecules