George Mazonakis had gone to the Stem Cell unit in Kolonaki on Wednesday afternoon (9/9) to undergo a scheduled plasmapheresis treatment. He had made a first appointment the day before, while the procedure was scheduled for the following day.
While preparing for treatment and after a venous catheter had been placed, the singer, according to the clinic, felt severe chest pain and then suffered a cardiac arrest.
The people in the unit immediately began resuscitation efforts with CPR, which were continued by the EKAB rescuers and later by the doctors of "Elpis" hospital, but it was not possible to revive him.
After the incident, the treatment itself that he had been scheduled to undergo, as well as the regime under which it could be carried out in this particular unit, came into focus.
Stem Cell doctor couple released
It is recalled that yesterday, as part of the investigation, the pathologist, 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 in the context of the ongoing investigation.
According to information, Stem Cell's doctor claimed that Giorgos Mazonakis was overexcited and that he contacted them in anticipation of a concert he would be giving in 20 days.
According to the same information, the doctor told the police that she was the one who suggested plasmapheresis treatment to Giorgos Mazonakis.
The doctor's lawyer, Nikos Agapinos, emphasized that the crucial element for the course of the case is the forensic examination, as it must be determined whether there is any connection between the death of Giorgos Mazonakis and the medical procedure to which he had been subjected.
The owner of the clinic, according to reports, denied any involvement in the incident, claiming that his wife had full management of the clinic, carried out the treatments and monitored the patients.
For its part, the prosecution requested that more information be gathered about both the circumstances of the singer's death and the plasmapheresis procedure to which he had undergone.
As mentioned, it is being examined whether this specific procedure was carried out in accordance with the prescribed framework, as according to current regulations, plasmapheresis should be performed by a hematologist in a public hospital and not in a private practice.
What exactly is plasmapheresis?
Therapeutic plasmapheresis is a recognized medical procedure and has been used for years for specific conditions. It is a procedure in which the patient's blood is passed through a special machine, which separates the plasma from the other components of the blood.
Then, 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 from the circulation substances that, in certain diseases, burden the body or participate in the progression of the disease.
Plasmapheresis is mainly used in selected hematological, neurological, nephrological and autoimmune diseases. In some cases it can be applied when pathological antibodies or other substances circulating in the blood need to be rapidly reduced. The treatment is legal and included in official treatment protocols.
This, however, does not mean that it can be performed in any location or in any doctor's office.
Plasmapheresis is not a simple intravenous treatment. It requires a special machine, safe vascular access, continuous monitoring of the patient, and personnel who have the appropriate training for the specific procedure.
Side effects or complications may occur during treatment, such as a drop in blood pressure, disturbances in calcium levels, allergic reactions, or problems associated with vascular access.
For this reason, the ability to receive immediate medical treatment is required in the event of an acute event.
What do NKUA professors say?
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 elements (red, white, platelets) are returned to the body.
The removed plasma is replaced with replacement fluid — usually 5% albumin and/or saline, and in special cases fresh frozen plasma.
The Doctors of the Therapeutic Clinic (Alexandra Hospital) of the Medical School of the National University of Athens, Konstantinos Giannakas (Hematologist) and Thanos Dimopoulos (Professor of Therapeutics - Oncology - Hematology, Director of Therapeutic Clinic, "Alexandra" Hospital, former Rector of the National University of Athens) report that the goal is twofold: on the one hand, the removal of pathogenic factors circulating in the plasma (e.g. autoantibodies, immune complexes, cryoglobulins, pathological proteins, toxins and lipids) and on the other, in certain diseases, the replenishment of factors through the replacement fluid.
Plasmapheresis procedure
-Vascular access: via two peripheral venous catheters (one for removal, one for reinfusion) or — in patients with difficult venous networks or the need for multiple sessions — via a dual-lumen central venous catheter.
-Blood separation: the blood is directed to the device, where separation occurs by centrifugation or membrane filtration. Anticoagulation with citrate salts prevents clotting in the circuit.
-Exchange volume: typically 1 – 1,5 plasma volumes are exchanged per session (approximately 3–4 liters in an adult), usually lasting 1,5 to 3 hours.
-Number of sessions: depends on the indication — usually 5–7 sessions, daily or every other day. During this time, the patient is continuously monitored for vital signs, fluid balance, and early signs of adverse reactions.
Indications for plasmapheresis
Indications are categorized internationally and the most recent guidelines (2023) list 166 indications, classified into four categories: Category I (first-line therapy), II (second-line/supportive), III (optimal role undetermined, individualized decision) and IV (contraindicated or ineffective).
Categories I–II include, but are not limited to:
• Hematological diseases: thrombotic thrombocytopenic purpura (TTP) — first-line treatment, where exchange removes autoantibodies against ADAMTS13 and replaces the deficient enzyme as well as hyperviscosity syndrome (e.g. in Waldenström macroglobulinemia, myeloma); Goodpasture syndrome; sickle cell disease (acute syndromes).
• 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).
• Transplants: antibody-mediated rejection (AMR) and desensitization before transplantation with ABO incompatibility or high HLA antibodies.
• Others: acute liver failure (as a bridge to transplantation), familial hypercholesterolemia, hypertriglyceridaemic pancreatitis
Under what safety conditions should it be done?
Plasmapheresis is generally considered a safe procedure, but it requires strict conditions:
• Organized blood collection or donation unit with specialized personnel, appropriate equipment and protocols for dealing with complications.
• Preoperative check-up: complete hematological and biochemical check-up (hematocrit, platelets, electrolytes — especially calcium, due to citrate), coagulation tests, assessment of vascular access and cardiorespiratory status.
• Continuous monitoring during the session: blood pressure, heart rate, oxygen, fluid balance.
• Sterile technique and proper management of the central catheter to avoid infections and thrombosis.
• Informed consent of 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 the use of plasma), catheter infection, bleeding, arrhythmias.
It is noted that after each session, clotting factors and immunoglobulins are removed, which requires attention to the risk of bleeding and the risk of infections.
The main question, therefore, in the case of the unit in Kolonaki is not whether plasmapheresis is a permitted treatment. The issue is whether the specific facility had the license required to perform such a medical procedure.
What did Adonis Georgiadis say?
The Minister of Health, Adonis Georgiadis, intervened in the matter, who stated in a post that the specific space had a license for a simple pathology clinic and not a license to perform plasmapheresis.
In his post, he spoke of a "supposed clinic" and noted that in a simple pathology clinic "such a medical procedure" as plasmapheresis is not allowed to be performed.
At the same time, he announced that he had asked the president of the Athens Medical Association to initiate an inspection to determine the exact operating conditions of the unit, as well as what happened before the singer's arrest.
The current framework provides for different categories for private Primary Health Care providers, with different conditions and possibilities for providing medical services.
Thus, the existence of a simple license to operate a medical practice does not automatically mean that the performance of every medical procedure is permitted.
The research
At the same time, authorities are investigating the circumstances under which the stop occurred.
The head of the unit went to the Kypseli Police Station to testify, while evidence is being collected about the medical procedures that had preceded it. One of the points that needs to be clarified is whether the plasmapheresis process had already begun or if Giorgos Mazonakis was still in the preparation stage.
The placement of an intravenous catheter alone does not necessarily mean that plasma exchange had begun.
At the same time, it should be clarified whether and to what extent there is any connection between the medical procedures performed at the unit and the arrest. This is an issue that will be judged by the medical and forensic data and not only by the chronological sequence of events.
Source: protothema.gr
