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SBB Review > Hemapheresis > Flashcards

Hemapheresis Flashcards

1
Q

How much will 1 volume exchange remove?

A

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

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2
Q

What is ECP or extracorporeal photopheresis?

A

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.

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3
Q

What diseases is ECP used for?

A

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

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4
Q

What is LDL apheresis?

A

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

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5
Q

What is the principle of ECP?

A

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

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6
Q

How much of IgG antibodies are in intravascular space?

A

45%

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7
Q

How much of IgM antibodies are in intravascular space?

A

76%

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8
Q

How much fibrinogen is in intravascular space?

A

80%

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

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9
Q

What is the anticoagulant used?

A

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)

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10
Q

What are the adverse effects of Citrate?

A

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

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11
Q

What is a vasovagal reaction?

A

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

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12
Q

desired catheter specifications

A

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

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13
Q

What is immunoadsorption?

A

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

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14
Q

What is Rheopheresis?

A

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.

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15
Q

Guilain-Barre (acute inflammatory demyelinating polyradiculoneuropathy)

A

TPE Category I

QOD (5-6)

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16
Q

ANCA associated rapidly progressive glomerulonephritis

A

TPE Category I

QD or QOD (6-9)

17
Q

Chronic inflammatory demyelinating polyradiculoneuropathy

A

TPE Category I

2-3/week

18
Q

Cryoglobulinemia

A

TPE Category II

QOD (3-8)

19
Q

Focal segmental glomerulosclerosis

A

TPE Category I

1-3/week

20
Q

HELLP

A

TPE Category III

21
Q

Hyperviscosity in monoclonal gammopathies

A

TPE Category I

QD (1-3)

22
Q

Immune thrombocytopenia

A

TPE Category III

QOD(6)

23
Q

Myasthenia gravis

A

TPE Category I

24
Q

Thrombotic thrombocytopenic purpura

A

TPE Category I

QD variable length based on patient response monitored by platelet count

25
Q

Wilson disease

A

TPE Category I

26
Q

Antibody mediated rejection of solid organ

A

TPE Category 1- non-ABO

TPE Category 2- ABO

27
Q

Hereditary Hemochromatosis

A

Erythrocytapheresis Category I

every 2-4 weeks

28
Q

Polycythemia Vera

A

Erythrocytapheresis Category I

29
Q

Sickle cell disease

A

Red cell exchange Category I

30
Q

Babesios (severe)

A

Red cell exchange Category II

31
Q

Thrombocytosis

A

Thrombocytapheresis Category II

32
Q

Cutaneous T-cell Lymphoma

A

Photopheresis Category I

Every 2-4 weeks (5-6 months)

33
Q

Graft vs Host

A

Photopheresis Category II

34
Q

Cardiac/Lung transplant rejection

A

Photopheresis Category II

35
Q

age related macular degeneration

A

Rheopheresis Category I

8-10 over 8-21 weeks

36
Q

familial hypercholesterolemia

A 
lipid apheresis Category I (homozygotes)
Category II (heterozygotes)

SBB Review (24 decks)

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