Public opinion in Greece and Cyprus has been shaken by the death of popular singer Giorgos Mazonakis at the age of 54. According to reports in the Greek media, the well-known artist had gone as scheduled to a medical center in Kolonaki for specialized plasmapheresis treatment, where he suffered a cardiac arrest. He was transported by ambulance to Elpis Hospital, where, despite the doctors’ efforts, he passed away at 5:40 p.m.

SEE ALSO: Here is the medical statement regarding the death of Giorgos Mazonakis

Plasmapheresis, or therapeutic plasma exchange (Therapeutic Plasma Exchange – TPE) is a specialized extracorporeal therapeutic method used to remove pathological substances from blood plasma. In recent years, its use has increased significantly, particularly in the treatment of neurological, hematological, nephrological, and autoimmune diseases. According to the guidelines of the American Society for Apheresis (ASFA, 2023–2024), plasmapheresis is currently considered a first-line treatment for certain serious diseases, while for other conditions it is used as an adjunct to medication.

The method is based on the mechanical removal of plasma containing autoantibodies, immune complexes, inflammatory cytokines, or toxic substances, and its replacement with albumin or fresh-frozen plasma. This approach achieves a rapid reduction in the pathological factors involved in the progression of the disease.

SEE ALSO: This is the cause of Giorgos Mazonakis’s death

Historical Overview

The first applications of plasmapheresis began in the 1950s, while its systematic clinical use developed in the 1970s with the advancement of extracorporeal circulation machines (Sanchez & Balogun, 2021). Initially, it was used primarily in patients with hyperviscosity and hematological disorders. Subsequently, improvements in technology allowed for its application in autoimmune and neurological diseases.

Today, plasmapheresis is considered an integral part of intensive care in many units worldwide, and its indications are constantly expanding through newer studies and clinical protocols.

READ ALSO: From Nice to the concert halls of the pentagram: The life and career of Giorgos Mazonakis

What Is Plasmapheresis?

Plasmapheresis is an extracorporeal procedure in which blood plasma is removed and replaced with special solutions. The patient’s blood passes through a special filter or centrifuge system that separates the plasma from the formed elements of the blood.

Red blood cells, white blood cells, and platelets are returned to the body along with the replacement fluid. The treatment can be performed using either membrane filters or a centrifugal technique, depending on the available equipment and the patient’s clinical condition.

The goal of this method is the rapid removal of substances responsible for causing or exacerbating the disease. These substances may include:

• Autoantibodies
• Immune complexes
• Cryoglobulins
• Paraproteins
• Inflammatory mediators
• Toxins or drugs

SEE ALSO: From Nice to the concert halls of the pentagram: The life and career of Giorgos Mazonakis

How the procedure is performed

Plasmapheresis is usually performed in specially equipped hemodialysis units, plasmapheresis units, or intensive care units.

First, vascular access is established via a central venous catheter or, in some cases, via peripheral veins. The blood is directed to the plasma exchange machine, where the plasma is separated from the cellular components.

The removed plasma is replaced by:

• 5% albumin solution
• Fresh frozen plasma
• A combination of albumin and normal saline

Each session typically lasts between 2 and 4 hours. Most patients require 3 to 7 sessions, depending on the disease and their response to treatment.

During the procedure, continuous monitoring of vital signs, blood pressure, coagulation, and electrolytes is required, as complications such as hypotension, hypocalcemia, allergic reactions, or coagulation disorders.

SEE ALSO: Shock across Greece: Giorgos Mazonakis died of cardiac arrest at age 54

For which conditions is it used?

Plasmapheresis is currently used to treat a wide range of conditions. The main indications include:

Neurological disorders

• Myasthenia gravis
• Guillain-Barré syndrome
• Chronic inflammatory demyelinating polyneuropathy
• Autoimmune encephalitis
• Multiple sclerosis with severe relapses

Studies in recent years show significant improvement in myasthenia gravis and Guillain-Barré syndrome, particularly when treatment is administered early (Ipe et al., 2021; Stoian et al., 2021).

Hematologic disorders

• Thrombotic thrombocytopenic purpura
• Hyperviscosity syndrome
• Waldenström’s macroglobulinemia
• Hemolytic uremic syndrome

Nephrological and autoimmune diseases

• ANCA-associated vasculitides
• Goodpasture syndrome
• Systemic lupus erythematosus
• Rapidly progressive glomerulonephritis

Other Indications

• Poisonings
• Severe hypertriglyceridemia
• Transplant rejection
• Severe inflammatory conditions in the ICU

During the COVID-19 pandemic, its use was also investigated in patients with severe inflammatory reactions and cytokine release syndrome (Koball et al., 2022).

SEE ALSO: Giorgos Mazonakis: The last post about the concert he didn’t get to perform

Results and Effectiveness

The effectiveness of plasmapheresis depends on the disease, the stage of the disease, and the timing of treatment.

In myasthenia gravis, treatment often leads to rapid improvement in muscle strength and respiratory function (Ipe et al., 2021). During myasthenia gravis crises, it can prove lifesaving by reducing the need for prolonged mechanical ventilation.

In Guillain-Barré syndrome, plasmapheresis has been associated with faster neurological recovery and a shorter length of stay in the ICU (Stoian et al., 2021).

In thrombotic thrombocytopenic purpura, it is considered the treatment of choice, as it significantly reduces mortality when initiated immediately.

At the same time, this method is often used as a “bridge” until immunosuppressive therapies take effect (Tonev & Momchilova, 2023). This is particularly important in severely ill patients who require an immediate reduction in circulating autoantibodies.

However, plasmapheresis is not a definitive cure for most autoimmune diseases. Pathological factors may recur, which is why it is often combined with corticosteroids, immunosuppressants, or biologics.

SEE ALSO: “There are times when I say I can’t take it anymore”: Mazonakis’s final interview on Alpha Cyprus

Possible complications

Although it is considered a relatively safe procedure when performed by qualified personnel, plasmapheresis may be associated with complications (Mahmoud et al., 2021).

The most common are:

• Hypotension
• Hypocalcemia due to citrates
• Allergic reactions
• Coagulation disorders
• Central line-associated infections
• Hemorrhagic complications
• Electrolyte imbalances

For this reason, continuous monitoring by an experienced medical and nursing team is crucial for patient safety.

SEE ALSO: This is the cause of Giorgos Mazonakis’s death

Criteria for patient enrollment in the treatment

Patient selection is based on international guidelines and an assessment of disease severity (ASFA, 2023–2024).

The basic criteria include:

• Confirmed diagnosis of a disease that responds to plasmapheresis
• Severe or rapidly progressing clinical presentation
• Failure of conventional therapy
• Presence of autoantibodies or pathological factors in plasma
• Absence of serious contraindications

Contraindications may include:

• Unstable hemodynamic status
• Severe coagulation disorders
• Uncontrolled sepsis
• Inability to establish vascular access

The decision to enroll a patient is usually made by a multidisciplinary team that includes nephrologists, hematologists, neurologists, and intensivists.

Hospitals in Greece where plasmapheresis is performed

Plasmapheresis is performed in Greece at specialized public hospitals and university medical centers, as well as at select private clinics that have extracorporeal therapy units and appropriately trained staff.

For example, the procedure is performed at hospitals such as:

• “G. Gennimatas” General Hospital of Athens 
• Laiko General Hospital of Athens 
• “Attikon” University General Hospital 
• AHEPA University General Hospital 
• Hippocrates Hospital of Thessaloniki 
• University Hospital of Patras 

The method is primarily used in nephrology, hematology, and intensive care units, and requires specialized equipment and interdisciplinary collaboration.

The Role of the Nursing Team

Nurses play a particularly important role in the success of plasmapheresis. Nurses are responsible for:

• Preparing the patient
• Monitoring vital signs
• Managing the equipment
• Recognizing complications
• Providing psychological support to the patient
• Patient and family education

Specialized nursing care helps reduce complications and improve the patient’s overall experience.

Conclusions

In modern clinical practice, plasmapheresis has become a particularly important therapeutic option for severe autoimmune, neurological, hematological, and nephrological diseases. Its ability to rapidly remove pathological agents from plasma makes it particularly effective in critical situations.

Continuous advances in technology and treatment protocols have significantly improved the safety and efficacy of the method (Tonev & Momchilova, 2023; Sanchez & Balogun, 2021). At the same time, its application in specialized centers and collaboration among interdisciplinary teams ensure better outcomes for patients.

Plasmapheresis does not replace the primary treatment of diseases, but it often serves as a critical therapeutic tool that can save lives and significantly improve prognosis.

References

1. American Society for Apheresis (ASFA). Guidelines on the Use of Therapeutic Apheresis in Clinical Practice. Recent updates 2023–2024.
2. Ipe TS, Davis AR, Raval JS. Therapeutic Plasma Exchange in Myasthenia Gravis: A Systematic Literature Review and Meta-Analysis of Comparative Evidence. Frontiers in Neurology. 2021;12:662856. DOI: 10.3389/fneur.2021.662856
3. Koball S, Rogge J, Frimmel S, et al. Immunoadsorption and plasmapheresis in the ICU—A description of the frequencies and indications based on a single-center experience and a case report. Therapeutic Apheresis and Dialysis. 2022;26(Suppl 1):97-101. DOI: 10.1111/1744-9987.13848
4. Mahmoud SH, Buhler J, Chu E, et al. Drug Dosing in Patients Undergoing Therapeutic Plasma Exchange. Neurocritical Care. 2021;34(1):301–311. DOI: 10.1007/s12028-020-01046-z
5. Sanchez AP, Balogun RA. Therapeutic Plasma Exchange in the Critically Ill Patient: Technology and Indications. Advances in Chronic Kidney Disease. 2021;28(1):59-73. DOI: 10.1053/j.ackd.2020.10.001
6. Stoian A, Serban G, Bajko Z, et al. Therapeutic plasma exchange as a first-choice therapy for axonal Guillain-Barré syndrome: A case-based review of the literature. Experimental and Therapeutic Medicine. 2021;21(3):265. DOI: 10.3892/etm.2021.9653
7. Tonev DG, Momchilova A. Therapeutic Plasma Exchange in Certain Immune-Mediated Neurological Disorders: Focus on a Novel Nanomembrane-Based Technology. Biomedicines. 2023;11(2):328. DOI: 10.3390/biomedicines11020328
8. Wind M, Gaasbeek AGA, Oosten LEM, et al. Therapeutic plasma exchange in pregnancy: A literature review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2021;260:29-36. DOI: 10.1016/j.ejogrb.2021.03.018

*SOURCE: www.iatronet.gr