Hemapheresis Flashcards
How much will 1 volume exchange remove?
2/3 of substance are removed if large amounts are not in extravascular space.
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.
Heparin used for anticoagulant
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
(except LDL-heparin; also may be used for patients with risk of hypocalcemia- small children, renal failure)
What are the adverse 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
desired catheter specifications
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 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.
Guilain-Barre (acute inflammatory demyelinating polyradiculoneuropathy)
TPE Category I
QOD (5-6)
ANCA associated rapidly progressive glomerulonephritis
TPE Category I
QD or QOD (6-9)
Chronic inflammatory demyelinating polyradiculoneuropathy
TPE Category I
2-3/week
Cryoglobulinemia
TPE Category II
QOD (3-8)
Focal segmental glomerulosclerosis
TPE Category I
1-3/week
HELLP
TPE Category III
Hyperviscosity in monoclonal gammopathies
TPE Category I
QD (1-3)
Immune thrombocytopenia
TPE Category III
QOD(6)
Myasthenia gravis
TPE Category I
Thrombotic thrombocytopenic purpura
TPE Category I
QD variable length based on patient response monitored by platelet count
Wilson disease
TPE Category I
Antibody mediated rejection of solid organ
TPE Category 1- non-ABO
TPE Category 2- ABO
Hereditary Hemochromatosis
Erythrocytapheresis Category I
every 2-4 weeks
Polycythemia Vera
Erythrocytapheresis Category I
Sickle cell disease
Red cell exchange Category I
Babesios (severe)
Red cell exchange Category II
Thrombocytosis
Thrombocytapheresis Category II
Cutaneous T-cell Lymphoma
Photopheresis Category I
Every 2-4 weeks (5-6 months)
Graft vs Host
Photopheresis Category II
Cardiac/Lung transplant rejection
Photopheresis Category II
age related macular degeneration
Rheopheresis Category I
8-10 over 8-21 weeks
familial hypercholesterolemia
lipid apheresis Category I (homozygotes) Category II (heterozygotes)
