J Health Care Technol. 1985 Spring;1(4):279-98.
Blood has been recognized as the essence of life since ancient times. Bloodletting, however, was performed centuries ago to treat disease and prolong life. Seventy years ago selective removal of blood components from circulating blood was advocated as a therapeutic measure. However, manual procedures for blood removal, separation, and reinfusion were quite cumbersome and did not really lend themselves to daily clinical practice. In the last 15 years, technologies have been developed to allow separation of blood into its component fractions, selective removal of specific elements--either cellular products or liquid plasma--an reinfusion of the remaining blood. Early cell separators were designed to collect specific blood components from healthy donors for subsequent transfusion to critically ill patients. Apheresis techniques were found to reduce the amounts of some normal elements circulating in the donors' blood, and the procedure thus began to be used therapeutically to remove abnormal components and to reduce excessive quantities of otherwise normal blood components. Diffusion of automated cell separators quickly followed and apheresis procedures were applied as treatment for a variety of diseases and conditions. The efficacy of therapeutic apheresis in many rare or exotic diseases is well established. In others, the role of apheresis is less clear. By reviewing the medical benefits of therapeutic apheresis, access to treatment, and the costs resulting from broad applications, this assessment will assist health care professionals and policymakers to evaluate therapeutic apheresis technology.
自古以来，血液就被视为生命的精髓。然而，放血疗法在几个世纪前就已被用于治疗疾病和延长寿命。70年前，人们提倡从循环血液中选择性去除血液成分作为一种治疗措施。然而，手动进行血液去除、分离和回输的操作相当繁琐，并不真正适用于日常临床实践。在过去的15年里，已经开发出了一些技术，能够将血液分离成其组成部分，选择性去除特定成分——无论是细胞产物还是液体血浆——然后将剩余的血液回输。早期的细胞分离器旨在从健康供体中采集特定的血液成分，以便随后输给重症患者。人们发现单采技术可以减少供体血液中一些正常成分的循环量，因此该程序开始被用于治疗性地去除异常成分，并减少其他正常血液成分的过量。自动细胞分离器很快得到普及，单采程序被应用于治疗各种疾病和病症。治疗性单采在许多罕见或特殊疾病中的疗效已得到充分证实。在其他情况下，单采的作用尚不清楚。通过回顾治疗性单采的医疗益处、治疗途径以及广泛应用所产生的成本，本评估将有助于医疗保健专业人员和政策制定者评估治疗性单采技术。
