Apheresis
The term Apheresis is Greek in origin and it means 'to take away'. This is a medical technology wherein the blood of a donor/patient is passed through an apparatus that separates one particular required component. The separated portion is withdrawn and the remaining components are retransfused into the patient/donor. The components thus separated from the patient/donor includes, plasma, platelets or leukocytes. This procedure is adhered to as an extracorporeal therapy.
In the process of apheresis, whole blood is removed from the patient/donor. The components of whole blood are separated by a centrifuge or an instrument specially designed for this purpose. The apheresis procedure is often employed to obtain stem cells from peripheral blood of patients suffering leukemia, a blood disease. Stem cells are infused into the patient's blood stream in order to produce cells that eventually will mature into red blood cells, white blood cells and platelets.
In transplants such as bone marrow procedures, the sick person happens to be his/her own donor. Blood is drawn and at a later time reinfused into that patient's blood stream in a procedure known as autologous bone marrow transplant. When stem cells are obtained from a healthy person, the procedure is allogeneic bone marrow transplant. Here, another person, may or may not be related, is the donor. Apheresis has become essential in providing blood components for several types of therapies. The process of apheresis takes a couple of hours and the volunteer donor/patient undergoes apheresis to supply specific components.
Leukapheresis is the removal of PMNS, basophils and eosinophils for transfusion into patients whose PMNs are ineffective or in whom the traditional line of therapy has failed. LDL apheresis is the removal of low density lipoprotein in patients suffering from hypercholesterolemia. Erythrocytapheresis is the collection of red blood cells (RBCs) either two standard units of RBCs or one unit plus either plasma or platelets. This process is commonly known as 'double reds' or 'double red cell apheresis'.
Apheresis is used in stem cell harvesting for circulating bone marrow cells during transplantations. To collect sufficient stem cells, apheresis process is performed for at least two consecutive days, although at times five or even more procedures become necessary.
It is pertinent to understand that when apheresis system is adopted for therapy, the system is removing relatively small amounts of fluid, not more than 10.5 mL/kg body weight. That fluid which is removed must be replaced in order to maintain the intravascular volume.
The apheresis process is painless. Some patients/donors may experience lightheadedness, numbness or tingling of the nose, lips or fingers. These symptoms are short lived and treatable. Possible complications include bleeding in needle sites, thrombosis or clotting in blood vessels, or rarely surgical complications if a temporary apheresis catheter is inserted. Infection is always a risk as this procedure involves penetrating the skin and open access to blood vessels.
Hyperlipoproteinemia
Too much of lipid and/or lipoproteins in the blood can lead to hyperlipoproteinemia. Hyperlipoproteinemia is also known as hyperlipemia or hyperlipidemia and is a metabolic disorder. This disease remains silent for years together; only when the person suffers any heart ailment does this condition come to light. Heredity and diet play a major role in the onset of this disease; hereditary blood fat disorders are the main cause for hyperlipoproteinemia.
Other common conditions that can cause this condition are diabetes, liver and kidney disease, hypothyroidism, alcohol and cigarette smoking. Few medications like progesterone, beta blockers, etc also increase the fat level in the bloodstream. If left unattended or untreated hyperlipoproteinemia can lead to cardiovascular and cerebrovascular diseases. This condition is common in adults rather than in children and can occur both in men and women. Depending on the excessive chemical found in the blood stream, hyperlipoproteinemia can be classified into five types:
Type I – Elevation of triglycerides
Type II – Elevated cholesterol and in few cases elevated triglycerides
Type III – Elevated cholesterol and triglyceride levels with subsequent vascular diseases
Type IV – Elevated triglycerides alone but no risk of vascular diseases
Type V – Similar to type I
No specific symptoms are shown for hyperlipoproteinemia. In very rare cases when the fat level in the blood shoots up too high, fat gets deposited in the form of bumps in the skin and tendons, this is referred to as xanthomas. In few cases, the liver and spleen enlarge when the triglycerides level shoot up too high. This leads to pancreatitis causing severe abdominal pain. The diagnosis of hyperlipoproteinemia can be made by measuring the triglycerides, total cholesterol, lipid profile, LDL and the HDL levels in the blood.
- Patients should consume a healthy low-fat or fat-free diet. They should avoid saturated fat and polyunsaturated fat.
- Monounsaturated fat like olive oil is recommended and is the healthiest option.
- Medications are also prescribed to bring down the LDL, HDL levels and the cholesterol levels in the blood.
- Doctors would advice the person to lose weight if obese.
- Physical activity is also be recommended.
- Plenty of fresh fruits and vegetables should be consumed.
- Food items like oatmeal, oat bran, rice bran, citrus fruits, rice bran, strawberries, apple pulp, beans and peas should be consumed.
Cardiologist
Cardiologists are physicians who diagnose and treat ailments related to the cardiovascular system that comprises of the heart, arteries, and veins. Pediatric cardiologist is a physician who focuses on diagnosing and treating heart problems in infants, children and young adults. Cardiologists specialize in treatment of angina (chest pain), heart attack, heart failure, high blood pressure and irregular heart beats. A cardiologist has to complete medical school and undergo residency in internal medicine for a period of three years. Further three years of specialization in the field of cardiology is required. For pediatric cardiologists a specialization in pediatrics is required prior to cardiology specialization. Cardiologists are specialists who provide complete heart care; they can determine the working condition of a person's heart by means of different tests. The responsibilities of the cardiologist include:
- The primary function of a cardiologist is to check on how well a person's heart is working.
- They determine this by asking for various tests like the treadmill test (exercise electrocardiogram), and through procedures like angioplasty, cardiac catheterization etc.
- They offer treatments for the diagnosed heart diseases through interventional cardiology like angioplasty, where a mechanical device is used to set right the problem in the heart.
- They use electrophysiology that helps in treating the electrical functioning of the heart.
- They also have the additional responsibility of keeping control over the factors that determine the health of the heart such as blood pressure and cholesterol levels. These levels in the blood of a person are kept under control thus keeping the heart comfortably functioning.
Modern techniques used in the field of cardiology
With the advancement in the field of medicine, cardiologists have the access to the latest technologies like:
Auscultation: A stethoscope is used to identify and detect heart abnormalities and murmur in the heart.
Echocardiography: Ultrasonic waves are used to visualize the heart.
Electrocardiography: EKG instruments are used to monitor the electrical activity of the heart.
Holter monitor: Records the EKG for 24 hours and more non-stop.
Modern blood tests: Determining the levels of HDL, LDL, triglycerides, homocysteine, and C-reactive protein helps in easy identification of heart problems.
Stress testing: Determines the levels of stress and cardiac function of the heart.
Coronary catheterization: Functioning of the heart is determined by inserting catheter into the heart.
Bibliography / Reference
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