Abstract
Apheresis has been used in the treatment of severe systemic vasculitides, in conjunction with immunosuppressive therapies, for more than 40 years. The aim is to allow the rapid removal from plasma of auto-antibodies or circulating immune complexes. The main indications of plasmapheresis are ANCA-associated vasculitides with severe renal involvement and/or intra-alveolar hemorrhage, and anti-glomerular basement membrane disease (Goodpasture). Therapeutic use of plasmapheresis may broaden if the ongoing trial PEXIVAS shows their benefit in ANCA-associated vasculitides with moderate renal involvement or intra-alveolar hemorrhage. The two main techniques of apheresis used in systemic vasculitides are plasma exchange (by filtration, centrifugation or double filtration) and immunoadsorption. Their respective advantages and drawbacks are presented here. No superiority of one technique upon the other has been demonstrated to date in this indication.
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