Apheresis

Question 1

How much will 1 volume exchange remove?

Answer 1

2/3 of substance are removed if large amounts are not in extravascular space.

Question 2

What % of substance will remain after 1 volume exchange?

Answer 2

If substance is only intravascular then 36.8% will remain. If large amounts are extravascular then 60.8% will remain with 1 volume exchange

Question 3

How is TPE used to treat MM patients?

Answer 3

Used in hyperviscosity syndrome to remove paraproteins or M protein

Question 4

What is ECP or extracorporeal photopheresis?

Answer 4

Photopheresis separates lymphocytes from whole blood, exposes these cells to ultraviolet light in the presence of a photoactive agent and returns them to the patient.

Question 5

What diseases is ECP used for?

Answer 5

Used in cutaneous T-Cell leukemia, GVHD and solid organ rejection

Question 6

What is LDL apheresis?

Answer 6

The specific removal of the cholesterol-containing particle low-density lipoproteins (LDL) from the blood stream. Used in patients with severe hyper-cholesterolemia where diet and medications are ineffective.

Question 7

What is the principle of ECP?

Answer 7

Buffy coat is removed and treated with 8-Methoxy Psoralen that crosslinks DNA in WBC causing cell death
ECP has complex immunomodulatory effects

Question 8

How much of IgG antibodies are in intravascular space?

Answer 8

45%

Question 9

How much of IgM antibodies are in intravascular space?

Answer 9

76%

Question 10

How much fibrinogen is in intravascular space?

Answer 10

80%

*Fibrinogen will decrease 60-80% per 1 volume exchange

Question 11

What is the anticoagulant used?

Answer 11

Citrate. Binds to free calcium to prevent coagulation

Can causes hypocalcemia

Question 12

What are the side effects of Citrate?

Answer 12

Perioral and/or peripheral paresthesia
Nausea, vomiting, lightheadedness, shivering, twitching
Tetany = rare
Vasovagal reaction

Question 13

What is a vasovagal reaction?

Answer 13

Most common. Pallor, diaphoresis, hypotension, and/or bradycardia – mild reactions
Nausea, vomiting, syncope and/or convulsions - severe reactions
Slow pulse rate is a useful sign differentiating vasovagal from hypovolemia

Question 14

What are examples of category I indicator for TA?

Answer 14

Guillain-Barre Syndrome
TTP/HUS
Hyperviscosity in monoclonal gammopathies
Myasthenia gravis – moderate/severe
Sickle Cell Disease – Acute Stroke

Question 15

What are examples of category II indicator for TA?

Answer 15

Symptomatic thrombocytosis
Sickle Cell DS (acute chest, prophylaxis)
GVHD - Skin (Photopheresis)
Renal Transplantation – Ab. Mediated Rejection

Question 16

What are examples or category III indicator for TA?

Answer 16

Acute liver failure
Scleroderma (TPE, Photopheresis)
Thyroid Storm
AIHA

Question 17

What are examples or category IV indicator for TA?

Answer 17

ALS
Coagulation Factor Inhibitors
ITP
Atypical HUS 
(Membrane Cofactor Protein Mutations) 
Amyloidosis, Systemic
RA

Question 18

How do minimize hypovolumemia?

Answer 18

Only 15% of BV should be removed

Prime machine with RBC’s or Colloid solution

Question 19

What is the “perfect catheter”?

Answer 19

double lumen, staggered port, large bore lumen catheter of minimum length and sufficient firmness with biocompatibility/resistance to infection
17 gauge needle for withdraw and 18 gauge catheter for return of blood

Question 20

What are the complications of fluid shifting?

Answer 20

Changes in intravascular volume may induce hemodynamic alterations such as Fluid overload (CHF, renal patients) or Hypovolemia

Question 21

How much plasma is removed in 1.0 Volume exchange?

Answer 21

65%

Question 22

How much plasma is removed in 1.5 Volume exchange?

Answer 22

75%

Question 23

How much plasma is removed in 2.0 Volume exchange?

Answer 23

88%

Question 24

How much plasma is removed in 2.5 Volume exchange?

Answer 24

92%

Question 25

How much plasma is removed in 3.0 Volume exchange?

Answer 25

96%

Question 26

What is the nadlers chart for plasma volume calculation?

Answer 26

Height, weight, and HCT are used to calculate PV

Question 27

What is immunoadsorption?

Answer 27

Prosorba column – single-use; contains inert silica particles coated with staphylococcal Protein A.
Binds Fc portion of IgG and IgG that is complexed in circulating immune complexes
NOT available in US

Question 28

What is Rheopheresis?

Answer 28

Used for treatment of dry age-related macular degeneration (AMD).
Composed of a filter to separate plasma from RBCs. Plasma is then run through a membrane filter that eliminates high molecular weight proteins. The filtered plasma is recombined with the patient’s RBCs and returned.