Hematologist Sotiris Koumas issues a clear warning against the use of plasmapheresis outside of established therapeutic indications, emphasizing to CNA that it is a medical procedure that can cause complications ranging from mild to severe and “must be performed at specialized centers.” Regarding its use for anti-aging purposes, Mr. Koumas states that he is unaware of whether it is practiced in Cyprus, emphasizing that “the first rule of medicine is to do no further harm.”
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Speaking to CNA, in light of the public debate that has arisen surrounding the death of George Mazonakis and the reports regarding plasmapheresis and anti-aging treatments, Mr. Koumas made it clear that he is not participating in this particular public debate, while also explaining what plasmapheresis is and in which cases it is used as a therapeutic method.
As he noted, plasmapheresis is a specific medical procedure with a wide range of applications across several medical specialties, including hematology and neurology, and in some cases is also used in rheumatology. He explained that it essentially involves the exchange of the patient’s plasma. Plasma is the liquid component of blood, through which various molecules—including proteins, antibodies, and clotting factors—are transported. In pathological conditions, he added, this liquid component may contain elevated levels of pathological proteins, autoantibodies, or other substances, which may cause harm to the patient if left untreated.
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Timely treatment is critical
As a prime example, he cited thrombotic thrombocytopenic purpura, noting that in many cases plasmapheresis is essential and that early diagnosis and initiation of treatment can be critical for survival. “The earlier you make the diagnosis, the earlier you begin plasmapheresis—and we’re talking about hours—the better the patient’s chances of survival,” he said.
Mr. Koumas also expressed satisfaction with the level of cooperation achieved among Cyprus’s public hospitals in managing cases requiring plasmapheresis. As he explained, such a procedure may require the collaboration of hematologists, nephrologists, intensive care specialists, and surgeons, as well as specialized nursing staff. He cited as an example a case in which, as he said, the initial diagnosis was made within an hour and the machine was available to begin plasmapheresis within four hours. “We have the team; we have the specialized nursing staff,” he said, noting that this is a procedure requiring expertise and the ability to immediately address potential complications.
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From Bleeding to Arrhythmia
Referring to potential complications, the hematologist noted that these can range from mild to particularly serious. As he explained, inserting a catheter can cause injury or bleeding, while the catheter—which remains in place for as long as the sessions are needed—can become infected or develop a blood clot. During plasmapheresis, he explained, the patient’s blood passes through a special machine and filters; the plasma is removed, while the blood cells (red blood cells, white blood cells, and platelets) are returned to the patient. At the same time, he said that a fluid is administered to replace the plasma that is removed. “This fluid may, depending on the indication and method, be donor plasma,” he noted.
Mr. Koumas explained that plasma, as a biological agent, can cause an allergic reaction, which may require anything from simple antiallergic treatment to more significant medical interventions. In addition, there may be a drop in blood pressure or electrolyte imbalances, which in some cases may lead to arrhythmia. He emphasized, however, that these are known risks of the procedure, which can be managed in an appropriate hospital setting. “That is why plasmapheresis must be performed at specialized centers, for specific therapeutic indications,” he noted.
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He does not know if it is used for anti-aging purposes
When asked whether plasmapheresis is used in Cyprus for anti-aging purposes rather than to treat a specific disease, Mr. Koumas replied that he did not know. He referred the matter to the competent authorities, who, as he said, can provide information on the purposes for which this specific method is used and whether there is relevant evidence within the framework of approved scientific protocols. “In public hospitals, I apply the therapeutic approach within the framework of the recommended protocol,” he said. Mr. Koumas also noted that he has not investigated how many centers in Cyprus have the capability to perform therapeutic plasmapheresis, while referring to centers that have recently opened and the publicity surrounding this specific method.
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“Inspections must also be strengthened”
Regarding the regulatory framework for such centers in Cyprus, the hematologist noted that the competent authority is the Ministry of Health, through the General Directorate of Medical Services and Public Health Services. As he explained, there are supervisors and inspectors, and specific requirements that facilities and services must meet in order to be licensed. He noted, however, that beyond the technical framework, effective oversight of the services provided must also be ensured. “Inspections must also be strengthened. And yes, everyone must be inspected,” he said.
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“Do no further harm”
When asked what he would say to someone requesting a blood transfusion solely for anti-aging purposes, Mr. Koumas replied, “That’s not part of my specialty; I don’t know.” At the same time, he invoked the fundamental rule of medicine, which, in his view, is “do no further harm.” “Even with a patient who is ill, if you don’t know what to do, it’s better not to intervene, so as not to cause further harm,” he said. Referring to prevention, he noted that medicine can effectively address factors such as cholesterol, smoking, and alcohol consumption. “Doctors often say that prevention accounts for 50% of treatment,” he noted. Finally, Mr. Koumas noted that in cases treated with therapeutic plasmapheresis at public hospitals, the results, as he put it, fall “within the range of international success and failure rates,” emphasizing that, as with any medical treatment, “there are also failures.”
