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SBB > Hemapharesis > Flashcards

Hemapharesis Flashcards

1
Q

Hemapheresis

A

Apheresis- means to separate out through force, hema-blood. Blood is removed and then separated into different components, some being retained/discarded while others are returned to the patient/donor

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2
Q

Where did the idea for apheresis technology come from?

A

Continuous flow centrifugation cream separator invented in 1877

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3
Q

Why do we add anticoagulant during apheresis

A

because you don’t want the blood to clot when you pull it out of the patients

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4
Q

Anticoagulant used during apheresis

A

citrate is most common but heparin or a combination of both have been used

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5
Q

How are the blood components separeated

A

either using a filter (sepeation based off size) or centrifugation (cell seperation based off cell density) typically centrifugation is how it’s separated

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6
Q

HES

A

hydroxy ethyl starch- WBCs and RBCs have similar densities in order to ensure separation you add HES and it causes reduction of zeta potential on RBCs so that they have a rouleaux effect and stick together, its much easier to separate from the WBCs “Sedimenting Agent”

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7
Q

apheresis column technology

A

uncommon, is used to push the specified blood component through this column (adsorption) to adsorb out what ever you want to eliminate from the component i.e. specific antibody or LDL at pathogenic levels

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8
Q

Discontinuous vs. continuous apheresis

A

usually in patients it’s continuous, meaning you are both pulling blood out, separating it while transfusing back the portion that you are not concerned about with some form of subsitute of what will be lacking. In donor’s it’s usually discontinuous, they usually pull the donation then spin it down and then transfuse it back later on. Discontinuous (Large extracorporeal volume) continuous (small extracorporeal volume)

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9
Q

membrane separation

A

basically filtration with membrane that is too small for rbcs to cross, allows plasma through

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10
Q

Filtration

A

not commonly seen in US, not mainly platforms are FDA approved and it’s only good for plasmapheresis

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11
Q

Filtration

A

not commonly seen in US, not mainly platforms are FDA approved and it’s only good for plasmapheresis/ plasma exchange

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12
Q

Efficiency of plasma proteins removal in 1 volume exchange

A

60-65% of plasma proteins good and bad are removed with one volume plasma exchange

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13
Q

uses of RBC exchange through apheresis

A

malarial infection, sickle cell disease

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14
Q

Leukapheresis

A

seperating out blood cells, usually done in patients with extremely high white counts due to Leukemia (AML most common)>CML>ALL not usually CLL

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15
Q

Reasons for plasmapheresis/ exchange

A 
HUS, TTP, Guillain Barre Syndrome
Myasthenia Gravis
CIDP- chronic inflammatory demylenating polyneuropathy
Autoimmune Renal Disease
Hyperviscosity Syndromes
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16
Q

Essential thrombocytosis

A

Essential thrombocytosis (primary thrombocythemia) is a nonreactive, chronic myeloproliferative disorder in which sustained megakaryocyte proliferation leads to an increase in the number of circulating platelets. with this you could bleed or clot, if the count is very high there is a lot of binding to vwF, stimulating almost vwDisease state, where bleeding occurs

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17
Q

reasons for thromapheresis

A

removal of platelets with thrombocytosis

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18
Q

What aspect do apheresis machines need to be able to control

A

the Separation Factor

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19
Q

Elutriation

A

a combination of centrifugation and filtration for cell separation

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20
Q

List components from least dense to most dense

A

Plasma> platelets> lymphocytes> monocytes>granulocytes > RBCs

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21
Q

Packing factor

A

same as separation factor just different term. This is a combination of the centrifugal time and the centrifugal acceleration rate(G).

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22
Q

Continuous

A 
 Blood is processed and separated
in a continuous way.
 Once the tubing set is primed, the
separation chamber is not
emptied till the end of the
process.
 Medium – small ECV.
 No pediatric tubing sets are
necessary; instead, a blood prime
is performed with smaller
patients.
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23
Q

Discontinuous

A 
Blood is processed in batches of a
size that can be tolerated by the
subject.
 Once the separation of that blood
is completed, the separation
chamber must be emptied to
repeat the process (cycle) again.
 Large extracorporeal volume
(ECV).
 Pediatric tubing sets (with smaller
ECV) must be used with small
patients.
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24
Q

Discontinous centrifugal apheresis systems

A

 Haemonetics: PCS-2, MCS+ 8150 and 9000, Cymbal

 Therakos UVAR-XTS

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25
Q

Continuous centrifugal apheresis systems

A

TerumoBCT: COBE Spectra, Trima, Trima Accel, Spectra
Optia
 Fenwal (Fresenius Kabi): Amicus, Alyx.
 Fresenius Kabi: AS 104, Com.Tec

26
Q

Tubing of apheresis machines

A

sterile and disposable plastic- for one time use

27
Q

Risks to hemapheresis

A

bleeding, bruising, clot, infiltration-infrection, also citrate reaction

28
Q

Citrate reaction symptoms

A

tingling numbness funny sensation around mouth and vibration in chest if no action is taken can worsen to convulsions tetany or cardiac arrhythmia

29
Q

Citrate reaction treatment

A

pausing aphereis, oral calcium then slow down the rate and IV calcium if necessary

30
Q

Vasovagal reaction

A

h.r. and b.p drop fainting, more common in donors then patients

31
Q

Rare hemapheresis reactions

A

allergic reaction ( to sterilizing gas used in kit preparation or any other component? air embolism (blood blockage due to air bubble) and hemolysis but this is rare with current technology and following procedures, If central venous line placement risks involved with making that placement

32
Q

difference in extravascular/intravascular

A

The problem is the concentration between the two, if we remove antibodies/cells from the intravascular space and put back in the body the concentration between the extra/intra vascular spaces will be different causing it to equalize by moving things back to the intravascular space to compensate

33
Q

How effecient is apheresis

A

typically 60-65%

34
Q

Maximum of donor’s blood volume that can be collected through apheresis

A

15%

35
Q

how many red cells can be collected during donor apheresis

A

two red cell bags, or one red cell and one other type of component bag

36
Q

How many platelets can be derived from an apheresis donation

A

single, double or triple plus one bag of either red cells or plasma

37
Q

How many plasma units can be derived from an apheresis donation

A

4 plasma units at one time or platelet/plasma/red cell combination

38
Q

How frequently can donor donate DR

A

Double red, two red cell units through apheresis, can be donated only 3 times in one year, must wait 1 weeks

39
Q

Lipid removal

A

liposorver technology- closed circuit with columns. first filtration removes plasma, returns red cells to patient. Plasma goes through propriety column removes ‘bad cholesteral’ two columns alternate one is being flushed so it can process additional plasma

40
Q

Lipid removal is used for:

A

Familial hypercholesteremia the mainindication. Long four hour procedure done every two weeks for persons entire life

41
Q

Platelet Depletion - what is is, why it’s done

A

can be done to decrease the count attempt to avoid complications but no a definitive treatment, chemotherapy must follow. Too many platelets as high as 1 million, bleeding or clotting, organ function compromised, myeloproliferative disorder such as polycythermia vera

42
Q

Leukodepletion- what it is why it’s done

A

too many whites cells especially sticky blasts (above 100k) AML and CML are more common, may be used in ALL not really used in CLL. With sticky blasts and increased white blood cells it makes blood more viscous and sludgy. causes lung and brain functionality problems, this is an urgent procedure in a sick patient, usually exchange two blood volumes. Must be followed by chemotherapy, leukodepletion is not a definitive treatment

43
Q

Photopheresis machine

A

Therakos cellex photophoresis machine, only machine on market in US

44
Q

what is photophoresis

A

works by collecting mononuclear cells and then exposing them to UV rays after addition of psoralen, can be done using machine, all steps in one, or you can collect the MNC separately and then do the addition of psoralen/UV infuse back separately

45
Q

what is photophoresis used for?

A

Graft vs. host disease in BMT, and cutaneuous T cell lymphoma and solid organ rejections, this can cause bleeding and photosensiyivity

46
Q

Immunomodulation

A

promotes immune system to decrease attacks on wrong targets in organ rejection and GvHD and increases their activity against tumor cells in lymphoma

47
Q

Red Cell exchange what it is

A

Must have good access in both arms, patients have been extensively transfused typically, Connected to a system that pulls out the whole blood, spins it down transfuses back the plasma portion and blood is then replaced with blood units

48
Q

Red cell exchange why it’s done

A

most common indication is sickle cell disease, eithr acute, or chronic to keep HGBS less than 30% prevent stroke. Can also be used as a treatment for severe malaria falciparum infection, by removing parasite infected red cells from circulation

49
Q

Avoiding iron overdose in red cell exchange

A

hemodilution can be used, replace 1-2 units with normal saline and then perform regular exchange

50
Q

Problemse with red cell exchang

A

Exposes patient to a lot of donors, if this is chronic regular treatment, hospitals matching for Rh and Kel to prevent alloimmunization

51
Q

Plasma Exchange -why

A

MOst common procedure done, TTP, Myasthenia Gravis and Guillain Barre syndrome, some kidney diseases and vasculitis syndromes. Idea is to removes disease causing antibody or immune complex

52
Q

Plasma exchange-how

A

Replacement fluid is either FFP (TTP) or more commonly 5% albumin. Albumin is usually supplemented with calcium to avoid citrate reaction, also if continual treatment, need to monitor PT/PTT levels of patient if receiving albumin, may need an FFP transfusion if prolonged.

53
Q

ASFA

A

American society for apheresis

54
Q

ASFA guidelines

A

has list of disease that apheresis treatment should work for, Category 1 and 2 are good, 3 needs to be discussed and 4 should not be done, based off of the expected response of the disease to the treatment

55
Q

patients that need apheresis:

A

are more likely to be admitted in a hospital, sick and needing skilled care, most procedures for this use central lines. you need a separate consent obtained by treating physicial as well as specific order for apheresis

56
Q

Therapy Donors

A

People that donate units of blood that is required to be removed as therapy in treatment of the patient. They have a separate DHQ, donation could be stimulated or unstimulated. Some of these are healthy donors and some are patients.

57
Q

Spectra Opia

A

equiptment used in extracting granulocytes, two arm continuis instrument

58
Q

Graunlocyte QC

A

must be 1 x 10^10 granulocytes and must be ABO compatible

59
Q

Important fact of granulocyte shelf life

A

only good for 24 hours, cannot wait for testing, donor is prescreened 48 hours prior

60
Q

Granulocyte donor and transfusion

A

Given simulating agent prior to collection commonly steroid G-CSF and sedimenting agent during collection, CMV status should be matched, should be irradiated usually donated by friends/family

61
Q

Platelet donor platelet count

A

must be greater than 150,000. Can use last value if obtained post donation and greater than or equal to 150,000

62
Q

Time interval between one red cell donation or whole blood donation

A

8 weeks, 56 days

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