Ch 18 Apheresis

Question 1

Removal of whole blood from a donor / recipient for the purpose of isolating a specific component or components, and then transfused back into the patient or discarded if components are septic of cancerous.

Answer 1

Apheresis

Question 2

3 techniques to perform apheresis?

Answer 2

• Centrifuge
• Membrane
• Adsorption

Question 3

Process in which granulocytes are separated from whole blood?

Answer 3

Leukapheresis

Question 4

Autologous and allogenic peripheral blood stem / progenitor cells (PBSCs / PBPCs) are isolated from whole blood by what pocess?

Answer 4

Cytapheresis

Question 5

Removal of diseased or defective components from an individuals blood?

Answer 5

Therapeutic Apheresis

Question 6

Diseased plasma can be removed and then replaced with what ?

Answer 6

• Albumin
• Crystalloids
• FFP

Question 7

Therapeutic Apheresis is used to treat what conditions?

Answer 7

• Waldenstrom’s macroglobulinemia
• Myasthenia gravis
• HYperviscosity syndrome
• thrombocytopenia
• Leukocytosis caused by leukamias

Question 8

Intraoperative blood salvage is the collection of blood that has been shed at the operative site during major surgery. This blood is collected and then re-infused into the patients. During which circumstances would this procedure be contraindicated?

Answer 8

• Bladder surgery / urine
• Open Bowel Surgery
• Malignancy
• Amniotic Fluid
• Sepsis

Question 9

Shed mediastinal blood collected from chest tubes, washed and reinfused. What is this procedure called?

Answer 9

Shed blood collection from post-operative drainage

Question 10

Advantage of shed blood collection ?

Answer 10

reduced donor exposure to RBC

Question 11

Disadvantage of shed blood collection ?

Answer 11

Plasma proteins washed away (does not improve clotting status)

Question 12

How can you reduce the prime volume ?

Answer 12

• Miniaturization
• Retrograde Autologus Prime
  (RAP)

Question 13

administered by injection to reduce bleeding during complex surgery, such as heart and liver surgery. Its main effect is the slowing down of fibrinolysis, the process that leads to the breakdown of blood clots. The aim in its use was to decrease the need for blood transfusions during surgery.

Answer 13

Aprotinin

Question 14

Aprotinin Binds with the human serine proteases; which decreases affinity. Name all 7 of them?

Answer 14

• Trypsin
• Plasmin
• Plasma kallikrein
• Tissue kallikrein
• Elastase
• Urokinase
• Thrombin

Question 15

Amicar AKA
– Epsilon amino caproic acid (EACA)
– Tranexamic acid (TA)

Answer 15

Synthetic antifibrinolytics that form reversible

complex with plasmin or plasminogen, preventing the lysis of fibrin

Question 16

Dosage of Amicar ?

Answer 16

100-150 mg/kg + 10-15 mg/hr

Question 17

2 Amicar Stats ?

Answer 17

– Blood loss reduced from 900 to 600 in first 24 hours

– Transfusion reduced from 4.2 - 2.8 units in 72 hours

Question 18

Erythropoietin

Answer 18

Used to stimulate erythropoiesis preoperatively.

• Simultaneous IV & IM administration 1 - 2 weeks pre-op.
• Several days to a week pos-op

Question 19

Desmopressin Acetate

Answer 19

• AKA DDA VP
• Synthetic Vasopression w/o the vasoconstriction effect.
• Mechanism: Increases circulation of VWF, VII, FVII and increases platelet adhesion.