Long COVID and ME/CFS: inpatient program with apheresis in Germany

Dr. Julian Douwes, Chief Medical Officer, designs the treatment protocols. Every plan depends on the diagnostic findings of the individual patient.

1. Diagnostics (1 to 2 days)

The diagnostics include an assessment of the microcirculation with capillaroscopy, microclot detection with fluorescence microscopy, and an immune profile with autoantibody screening. The diagnostics also include tests of mitochondrial function, tests of the autonomic nervous system and markers of the function of the blood vessels. Then the physician explains all findings to you in a results conference. The diagnostic program in detail

2. H.E.L.P. apheresis

H.E.L.P. apheresis is a procedure that filters the blood plasma outside the body. H.E.L.P. means heparin-induced extracorporeal LDL precipitation. Physicians developed the procedure for severe disorders of lipid metabolism. Blood leaves the body through a line in one arm. A machine separates the plasma from the blood cells. The machine removes LDL cholesterol, fibrinogen and inflammatory proteins from the plasma. The cleaned plasma and the blood cells return through a line in the other arm. A session takes about 2 to 3 hours. What H.E.L.P. apheresis involves

3. Immunoadsorption

Immunoadsorption is another form of apheresis. A machine separates the plasma from the blood cells. The plasma passes through a column that binds antibodies, mainly antibodies of the type IgG. The plasma then returns to the patient. The procedure needs no donor plasma. A session takes 2 to 4 hours, and a course consists of several sessions over several days. In some patients with Long COVID and in some patients with ME/CFS, laboratory tests find autoantibodies, antibodies that act against structures of the patient's own body. When the diagnostics detect autoantibodies, immunoadsorption may be considered, because the procedure removes antibodies from the blood plasma. The physician decides this case by case after the diagnostics. What immunoadsorption involves

4. The research background

Dr. Beate Jaeger is Chief Physician for internal and laboratory medicine at the hospital. Impaired microcirculation, fibrinoid microclots and endothelial dysfunction are the research direction we work on with her, and they are what the work-up looks for. The microclot finding itself comes from the international literature (Pretorius et al., 2021). Scientists are still investigating these mechanisms. The Long COVID program

5. Further therapies in the plan

Depending on your findings, the plan can include hyperbaric oxygen therapy, interval hypoxia-hyperoxia training (IHHT), immune therapy by infusion and paced physical therapy. Hyperbaric oxygen therapy, IHHT, immune therapy, the Long COVID treatment protocol and the ME/CFS treatment program

6. A schedule that respects your energy

The team plans 2 to 3 treatments per day with long rest periods between the treatments. The team adjusts the schedule every day to your energy level and to your response. The principle of the ME/CFS protocols is that no therapy should trigger post-exertional malaise, the worsening of all symptoms after physical or mental exertion. All apheresis procedures at the hospital