THERAPEUTIC APHERESIS

Question 1

An extracorporeal therapy used in the treatment and management of various diseases through removal and discarding of selected blood constituents.

Answer 1

Therapeutic apheresis (TA)

Question 2

Which of the following about therapeutic apheresis this NOT true?

A. Blood components are collected from blood donors
B. TA is accomplished through removal and discarding of selected blood constituents
C. TA is accomplished via the collection of selected blood elements with their subsequent ex-vivo manipulation and return to the patient
D. The goal of TA is to replace a deficient substance by removing a pathologic constituent.

Answer 2

A. Blood components are collected from blood donors

Selective blood constituents are taken and then returned to patient

Question 3

What is the most common clinical therapeutic apheresis procedure?

Answer 3

Plasma exchange/plasmapheresis

Question 4

What is the typical indication for extracorporeal photopheresis procedure (therapeutic apheresis modality)?

Answer 4

Chronic graft vs host disease

Question 5

Which is the most common complication/adverse effect of therapeutic apheresis?

A. Anaphylaxis
B. Nausea and abdominal pain
C. Hypocalcemia
D. Cardiac arrhythmia

Answer 5

C. Hypocalcemia

due to citrate anticoagulation: typically characterized by perioral and digital paresthesiae (abnormal sensation of the skin with no apparent cause)

Frequency:
Anaphylaxis = 0.02%
Nausea and abdominal pain = 0.39% and 0.12%
Arrythmia = 0.11

Question 6

True or false - intensive therapeutic plasma exchange (TPE) without plasma replacement depletes coagulation factors therefore bleeding in patients undergoing TPE is common.

Answer 6

FALSE

Coagulation factor levels are reduced but if the patient has normal hepatic synthetic function, coagulation factor levels typically return near normal within two days. Thus, many patients can tolerate TPE every other day for 1 to 2 weeks without developing significant coagulopathies requiring plasma replacement.

Question 7

True or false - fatalities during apheresis should be reported to the state.

Answer 7

FLASE

Report to FDA

Question 8

What is the goal (or being removed) in the following conditions in which therapeutic plasma exchange is indicated?

• TTP
• Multiple myeloma
• Antibody mediated rejection in organ transplant

Answer 8

• TTP - ADAMTS13 inhibitor & vWFmultimers
• Multiple myeloma - excessive amount of M proteins
• Antibody mediated rejection in organ transplant - immunosuppression / prevention of hyperacute rejection

Question 9

A type of therapeutic apheresis in which excessive pathogenic leukocytes, platelets or red cells are removed.

Answer 9

Cytapheresis

Question 10

The most common type of cytapheresis procedure performed in sickle cell disease

Answer 10

Red cell exchange

Question 11

What type of therapeutic cytapheresis procedure is done for patients with polycythemia vera?

Answer 11

Erythrocytapheresis

Question 12

Which of the following statements does not apply to red cell exchange in patients with sickle cell disease?

A. The goal is to reduce HgbS to less than 30%
B. The final Hct must not exceed ~30%
C. Donor cells are used to provide HgbA
D. Phenotypically matched RBC units must be used

Answer 12

D. Phenotypically matched RBC units must be used

Must be Rh and Kell matched - typically E-,C-, K- when possible

Question 13

A type of therapeutic apheresis where the Buffy coat is collected from peripheral blood then treated with 8-methoxypsoralen & UVA light then reinfused to patient.

Answer 13

Extracorporeal photopheresis

Question 14

Which off the following does not apply to extracorporeal photopheresis?

A. Treatment causes cross-linking of leukocyte DNA which prevents replication and induces apoptosis
B. Was developed to create cutaneous T-cell lymphoma
C. Is ineffective for treatment for skin GVHD
D. A layer of puffy coat is taken from patient circulation treated then reinforced to patient

Answer 14

C. Is ineffective for treatment for skin GVHD

It is effective in acute and chronic GVHD, but is less defined in non-skin GVHD

Question 15

Which organizational body periodically publishes guidelines and recommendations for the use of therapeutic apheresis in clinical practice?

Answer 15

American Society for Apheresis

Question 16

What component/solution is the most commonly used replacement fluid for therapeutic plasma exchange?

Answer 16

5% Albumin

Question 17

A type of therapeutic apheresis in which a specific component, such as high molecular weight plasma proteins, are selectively removed from blood or plasma.

Answer 17

Selective adsorption

Question 18

Which therapeutic apheresis modality is appropriate for patients with severe WAIHA or cold agglutinin disease experiencing hemolytic anemia?

Answer 18

Therapeutic plasma exchange

Question 19

Which therapeutic apheresis modality is appropriate for patients with hereditary hemachromatosis?

Answer 19

Erythrocytapheresis

Question 20

Which therapeutic apheresis modality is appropriate for patients with age related macular degeneration?

Answer 20

Selective adsorption (rheopheresis)

Question 21

Which therapeutic apheresis modality is appropriate for patients with cutaneous T-cell lymphoma?

Answer 21

Photopheresis

Question 22

Which therapeutic apheresis modality is appropriate for patients with TTP?

Answer 22

Therapeutic plasma exchange

Question 23

Which therapeutic apheresis modality is appropriate for patients with Wilson’s disease?

Answer 23

Therapeutic plasma exchange

Wilson’s disease - a genetic disorder where excessive copper builds up in the body

Question 24

Which structure of an immunoglobulin varies between antibodies and binds antigen?
A. Heavy chain and light chain variable domains
B. Heavy chain variable domain only
C. Light chain variable region only
D. Heavy chain constant domain only

Answer 24

A. Heavy chain and light chain variable domains

part of the Fab domain, antigen binding

Question 25

Which structure of an immunoglobulin differs between each isotypes/subclass and activates effector mechanisms?
A. Heavy chain and light chain variable domains
B. Heavy chain variable domain only
C. Light chain variable region only
D. Heavy chain constant domain only

Answer 25

D. Heavy chain constant domain only