On Wednesday afternoon (September 9), Giorgos Mazonakis went to the Stem Cell clinic in Kolonaki to undergo a scheduled plasmapheresis treatment. This followed an initial appointment the day before, and the procedure had been scheduled for the following day.

While preparing for the treatment and after an IV catheter had been inserted, the singer, according to clinic staff, felt intense chest pain and then went into cardiac arrest.

The unit’s staff immediately began CPR, which was continued by EKAB paramedics and later by doctors at “Elpis,” but she could not be revived.

Following the incident, scrutiny focused not only on the treatment she had been scheduled to undergo but also on the conditions under which it could be performed at that particular unit.

The two Stem Cell doctors have been released

As a reminder, yesterday, as part of the investigation, the internist, owner of the Stem Cell clinic in Kolonaki, and his wife, also a doctor, left the Kypseli Police Station shortly before midnight, after completing their statements as part of the ongoing investigation.

According to the doctor’s attorney, Nikos Agapinos, the two doctors were provisionally released, while authorities are expected to continue gathering evidence, including statements from employees and an on-site inspection.

The clinic’s owner, according to reports, denied any involvement in the incident, claiming that his wife was in full charge of the clinic, performed the treatments, and monitored the patients.

What exactly is plasmapheresis?

Therapeutic plasmapheresis is a recognized medical procedure and has been used for years to treat specific conditions. It is a procedure in which the patient’s blood passes through a special machine that separates the plasma from the other components of the blood.

Next, part of the plasma is removed, and the blood cells are returned to the body along with a special replacement fluid. The goal of the procedure is to remove substances from the bloodstream that, in certain diseases, place a burden on the body or contribute to the progression of the disease.

Plasmapheresis is primarily used for selected hematological, neurological, nephrological, and autoimmune conditions. In some cases, it may be used when pathological antibodies or other substances circulating in the blood need to be rapidly reduced. The treatment is legal and is included in official treatment protocols.

However, this does not mean that it can be performed in just any facility or clinic.

Plasmapheresis is not a simple intravenous treatment. It requires specialized equipment, safe vascular access, continuous monitoring of the patient, and staff who are properly trained in this specific procedure.

During treatment, side effects or complications may occur, such as a drop in blood pressure, abnormalities in calcium levels, allergic reactions, or problems related to vascular access.

For this reason, immediate medical intervention must be available in the event of an acute incident.

What professors at the National and Kapodistrian University of Athens say

Therapeutic plasma exchange (therapeutic plasma exchange—TPE) is a removal procedure—that is, a technique in which the patient’s blood passes through a special device that separates and removes the plasma, while the cellular components (red blood cells, white blood cells, platelets) are returned to the body.

The removed plasma is replaced with a replacement fluid—usually 5% albumin and/or normal saline, and in special cases, fresh frozen plasma.

The physicians at the Therapeutic Clinic (Alexandra Hospital) of the Medical School of the National and Kapodistrian University of Athens, Konstantinos Giannakas (Hematologist) and Thanos Dimopoulos (Professor of Internal Medicine, Oncology, and Hematology; Director of the Department of Internal Medicine, Alexandra Hospital; former Rector of the University of Athens) state that the goal is twofold: on the one hand, the removal of pathogenic agents circulating in the plasma (e.g., autoantibodies, immune complexes, cryoglobulins, pathological proteins, toxins, and lipids); and on the other hand, in certain diseases, to replenish these factors through the replacement fluid.

Plasmapheresis Procedure

–Vascular access: via two peripheral venous catheters (one for removal, one for replacement) or — in patients with difficult venous access or who require multiple sessions — via a dual-lumen central venous catheter.
–Blood separation: the blood is directed to the device, where separation occurs via centrifugation or membrane filtration. Anticoagulation therapy with citrate prevents clotting in the circuit.
–Exchange volume: Typically, 1–1.5 times the plasma volume is exchanged per session (approximately 3–4 liters in an adult), with a duration of usually 1.5 to 3 hours.
–Number of sessions: depends on the indication—usually 5–7 sessions, daily or every other day. Throughout the procedure, the patient is continuously monitored for vital signs, fluid balance, and early signs of adverse effects.

Indications for plasmapheresis

Indications are categorized internationally, and the most recent guidelines (2023) list 166 indications, classified into four categories: Category I (first-line treatment), II (second-line/supportive), III (optimal role undetermined, individualized decision), and IV (contraindicated or ineffective).

Categories I–II include, for example:

• Hematologic disorders: thrombotic thrombocytopenic purpura (TTP)—first-line therapy, in which exchange therapy removes autoantibodies against ADAMTS13 and replenishes the deficient enzyme, as well as hyperviscosity syndrome (e.g., in Waldenström’s macroglobulinemia, multiple myeloma); Goodpasture syndrome; sickle cell disease (acute crises).
• Neurological diseases: myasthenia gravis (crisis and preoperative preparation), Guillain-Barré syndrome—one of two proven effective treatments along with IVIG, chronic inflammatory demyelinating polyneuropathy (CIDP), acute relapses of multiple sclerosis unresponsive to corticosteroids.
• Nephrological/vasculitic: rapidly progressive glomerulonephritis with ANCA antibodies, atypical hemolytic-uremic syndrome (selected cases).
• Transplants: antibody-mediated rejection (AMR) and desensitization prior to transplantation in cases of ABO incompatibility or high HLA antibody levels.
• Other: acute liver failure (as a bridge to transplantation), familial hypercholesterolemia, hypertriglyceridemic pancreatitis

Under what safety conditions should it be performed?

Plasmapheresis is generally considered a safe procedure, but it requires strict conditions:

• An organized apheresis or blood donation unit with specialized staff, appropriate equipment, and protocols for managing complications.
• Preoperative evaluation: complete hematological and biochemical testing (hematocrit, platelets, electrolytes—particularly calcium, due to citrates), coagulation tests, assessment of vascular access and cardiorespiratory status.
• Continuous monitoring during the procedure: blood pressure, heart rate, oxygen saturation, and fluid balance.
• Sterile technique and proper management of the central catheter to prevent infections and thrombosis.
• Informed consent from the patient.

The most common side effects are:

1. Transient: reaction to citrates (tingling, muscle cramps, hypocalcemia), drop in blood pressure, fatigue after the session, hematoma at the puncture site.

2. Rarer but more serious: allergic/anaphylactic reactions (especially with plasma use), catheter infection, bleeding, arrhythmias.

It should be noted that after each session, clotting factors and immunoglobulins are also removed, which necessitates vigilance regarding the risk of bleeding and infection.

The key question, therefore, in the case of the facility in Kolonaki is not whether plasmapheresis is a permitted treatment. The issue is whether that specific facility had the necessary license to perform such a medical procedure.

What Adonis Georgiadis Said

The Minister of Health, Adonis Georgiadis, intervened in the matter, stating in a post that the facility in question held a license as a general pathology clinic and not a license to perform plasmapheresis.

In his post, he referred to a “so-called clinic” and noted that in a general medical practice, “such a medical procedure is not permitted,” such as plasmapheresis.

At the same time, he announced that he had asked the president of the Athens Medical Association to launch an investigation to determine the exact operating conditions of the facility, as well as the events leading up to the singer’s cardiac arrest.

The current regulatory framework establishes different categories for private primary health care providers, each with distinct requirements and capabilities for providing medical services.

Thus, simply holding a license to operate a medical clinic does not automatically mean that every medical procedure is permitted.

The Investigation

Meanwhile, authorities are investigating the circumstances under which the cardiac arrest occurred.

The head of the unit went to the Kypseli Police Station to give a statement, while evidence is being gathered regarding the medical procedures that preceded the incident. One of the points that needs to be clarified is whether the plasmapheresis procedure had already begun or whether Giorgos Mazonakis was still in the preparation stage.

The insertion of an intravenous catheter alone does not necessarily mean that the plasma exchange had begun.

At the same time, it must be clarified whether—and to what extent—there is any connection between the medical procedures performed in the unit and the cardiac arrest. This is a matter that will be determined by the medical and forensic evidence, and not solely by the chronological sequence of events.

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Source: PROTO THEMA