OPTIMIZATION OF THERAPEUTIC PROCEDURE DURING EXTRACORPOREAL LIPOPROTEIN ELIMINATION – A COMPUTERIZED MODEL

Extracorporeal elimination is a very effective method in the treatment of resistant hypercholesterolemia when other therapy (dietary, medicamentous) fails. To maximize efficacy of the usage of absorbers we aimed to create a computerized model.
Patients and methods: The therapeutic technique was used of immunoadsorption, applying a pair of columns Lipopak®, Pocard, Russia. Plasma was separated by continuous-flow plasma separator Cobe® Spectra™, USA; adsorption was controlled by adsorption-desorption equipment ADA, Medicap, Germany.  Repeated 494 LDL-apheresis procedures (treatment interval 17,5 + 1,6 days) has been used to treat eight patients with primary hypercholesterolemia followed over 3,6 + 0,5 consecutive years. Metabolism of the LDL-cholesterol is known to be multi-compartmental and dynamic, but in the short-time range of the procedure it can be simplified and the procedure can be assumed to be a continuous filtration. We developed a program for procedure planning, using Microsoft® Excel for Windows®. Inputs into the program include only basic patient data (mass, height, sex and initial plasma LDL level in mmol/L).  
Results: The results show a very promising match between our planning of the procedures and the real laboratory results. Calculated and real plasma LDL-cholesterol level drops differ no more than + 10 %.
Conclusions: Although our software does not take into account many well known details concerning the metabolism of cholesterol, in given conditions it can provide a fairly precise prediction of procedure parameters. It is also suitable for practical use, because it requires only a few commonly used and readily available input values. Immunoadsorption with Pocard absorbers is a potent and safe method of therapy in indicated patients.
Supported by research task MZO 00179906