Apheresis Flashcards
How much will 1 volume exchange remove?
2/3 of substance are removed if large amounts are not in extravascular space.
What % of substance will remain after 1 volume exchange?
If substance is only intravascular then 36.8% will remain. If large amounts are extravascular then 60.8% will remain with 1 volume exchange
How is TPE used to treat MM patients?
Used in hyperviscosity syndrome to remove paraproteins or M protein
What is ECP or extracorporeal photopheresis?
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.
What diseases is ECP used for?
Used in cutaneous T-Cell leukemia, GVHD and solid organ rejection
What is LDL apheresis?
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.
What is the principle of ECP?
Buffy coat is removed and treated with 8-Methoxy Psoralen that crosslinks DNA in WBC causing cell death
ECP has complex immunomodulatory effects
How much of IgG antibodies are in intravascular space?
45%
How much of IgM antibodies are in intravascular space?
76%
How much fibrinogen is in intravascular space?
80%
*Fibrinogen will decrease 60-80% per 1 volume exchange
What is the anticoagulant used?
Citrate. Binds to free calcium to prevent coagulation
Can causes hypocalcemia
What are the side effects of Citrate?
Perioral and/or peripheral paresthesia
Nausea, vomiting, lightheadedness, shivering, twitching
Tetany = rare
Vasovagal reaction
What is a vasovagal reaction?
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
What are examples of category I indicator for TA?
Guillain-Barre Syndrome TTP/HUS Hyperviscosity in monoclonal gammopathies Myasthenia gravis – moderate/severe Sickle Cell Disease – Acute Stroke
What are examples of category II indicator for TA?
Symptomatic thrombocytosis
Sickle Cell DS (acute chest, prophylaxis)
GVHD - Skin (Photopheresis)
Renal Transplantation – Ab. Mediated Rejection
What are examples or category III indicator for TA?
Acute liver failure
Scleroderma (TPE, Photopheresis)
Thyroid Storm
AIHA
What are examples or category IV indicator for TA?
ALS Coagulation Factor Inhibitors ITP Atypical HUS (Membrane Cofactor Protein Mutations) Amyloidosis, Systemic RA
How do minimize hypovolumemia?
Only 15% of BV should be removed
Prime machine with RBC’s or Colloid solution
What is the “perfect catheter”?
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
What are the complications of fluid shifting?
Changes in intravascular volume may induce hemodynamic alterations such as Fluid overload (CHF, renal patients) or Hypovolemia
How much plasma is removed in 1.0 Volume exchange?
65%
How much plasma is removed in 1.5 Volume exchange?
75%
How much plasma is removed in 2.0 Volume exchange?
88%
How much plasma is removed in 2.5 Volume exchange?
92%
How much plasma is removed in 3.0 Volume exchange?
96%
What is the nadlers chart for plasma volume calculation?
Height, weight, and HCT are used to calculate PV
What is immunoadsorption?
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
What is Rheopheresis?
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.
