The death of Greek singer Giorgos Mazonakis during a plasmapheresis procedure has received attention even outside Greece, while the case has opened discussions about the safety of this procedure and the conditions under which it is performed.
Dr. Allen P. Green, a clinical pathologist and associate medical director at a California apheresis center who says he has performed more than 500 plasmapheresis procedures, responded to the case in an article published on his website. He said that after Mazonakis' death, patients and doctors asked him whether the plasmapheresis procedure was life-threatening.
Referring specifically to the private clinic in Kolonaki where the incident occurred, Green emphasizes that, if the reported information is confirmed by investigations and courts, it concerns deficiencies that he considers essential for a safe affair program.
According to the American doctor, the three main elements are specially trained personnel for the procedure, functional equipment for dealing with emergencies, and clear criteria for immediate discontinuation of treatment.
Green also makes a distinction between the different procedures often referred to under the general term “plasmapheresis.” He explains that the INUSpheresis system, used in Mazonakis’ case, is a form of double-filtration plasmapheresis, where the plasma is separated from the blood cells, passed through a second filter, and then returned to the patient.
In therapeutic plasma exchange, the plasma is removed and replaced with a fresh albumin solution, Green says. Specific scientific data on INUSpheresis is limited, referring to the literature published so far.
The American doctor also questions how some clinics can offer such procedures, arguing that possessing an apheresis device does not equal specialization in its use. He warns that staff training and emergency preparedness are crucial elements.
Discussing the possible causes of a fatal incident during the procedure, Green mentions several scenarios, including the use of an inappropriate replacement solution, lack of pre-treatment laboratory testing, inadequate equipment, or failure to respond to warning signs.
Another point he highlights is the decision not to perform the procedure when a patient presents with new symptoms. According to Green, sudden confusion, difficulty speaking, a new cough, unexplained fluid retention or difficulty walking should initially prompt an urgent medical evaluation rather than automatically continuing with planned treatment.
However, Green emphasizes that the fact that a cardiac arrest occurs during a procedure does not in itself prove that the procedure caused it. According to him, what can determine whether a cardiac incident ends fatally are the first few minutes and the team's ability to immediately identify the problem, stop the procedure, begin resuscitation and activate emergency services.
In the case of Mazonakis, the autopsy, according to the information cited in the report, did not reveal a heart problem. The specific causes and responsibilities for the singer's death remain the subject of relevant investigations and procedures.
Among the potential risks during plasma removal procedures, Green mentions a decrease in ionized calcium, which can affect cardiac conduction, a rapid drop in blood pressure, especially in dehydrated patients or those taking antihypertensive medications, as well as problems that can arise if device alarms are not investigated promptly.
According to him, the safety of the procedure depends not only on the technology itself, but also on trained personnel, patient screening before treatment, monitoring during the procedure, and the immediate availability of medications, emergency equipment, and resuscitation services.
