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CCHS SBB > Therapeutic Apheresis > Flashcards

Therapeutic Apheresis Flashcards

1
Q

who publishes guidelines and recommendations for use of therapeutic apheresis in clinical practice?

A

American Society for Apheresis

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2
Q

who provides standards for voluntary compliance of therapeutic apheresis?

A

AABB

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3
Q

what standard defines regulations that govern apheresis activities for donors?

A

5.5 and 5.6

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4
Q

donor requirements for infrequenct plasmapheresis

A

collected for direct transfusion; minimum 4 weeks between donations

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5
Q

donor requirements for frequent plasmapheresis

A

minimum 2 day interval between donations
maximum 2 donations within 7 day period
limits to max volume removed per weight
max red cell loss 25 mL/week

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6
Q

what is source plasma?

A

plasma from serial donors, not used for direct transfusion

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7
Q

plateletpheresis donor requirements

A

meet allogeneic whole blood donor requirements
meet apheresis requirements
starting platelet count >150,000/uL
no aspirin within 48 hours of donation

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8
Q

plateletpheresis storage

A

5 day shelf life at 20-24C with gentle agitation; 4 hours open system

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9
Q

plateletpheresis donor requirements

A

minimum 8 weeks from whole blood donation
minimum 2 days between donations
maximum 2 donations within 7 day period
maximum 24 donations in 12 month period

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10
Q

how long after whole blood donation can a donor donate plateletpheresis?

A

8 weeks

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11
Q

how long after plateletpheresis can another single platelet be donated?

A

2 days

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12
Q

how many plateletpheresis donations are allowed in a 7 day period?

A

2

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13
Q

one plateletpheresis is equivalent in platelet count to how many platelet concentrates?

A

6-8

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14
Q

what is minimum platelet count per apheresis unit?

A

3x10^11

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15
Q

plateletpheresis must be suspended in enough plasma to maintain what pH?

A

6.2

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16
Q

donor height and weight requirement for red cell apheresis

A

must meet requirement of manufacturer of equipment used to collect apheresis

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17
Q

minimum age for red cell apheresis

A

17 years old

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18
Q

donor hematocrit for red cell apheresis

A

.40% male and female

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19
Q

donation interval between red cell apheresis units

A

16 weeks between donations

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20
Q

indications for leukapheresis

A

septicemia

severe neutropenia

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21
Q

why is hydroxyethyl starch added to apheresis circuit during leukapheresis?

A

promotes rouleaux to allow better separation of red cells and white cells

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22
Q

what is given to donors 8-12 hours before leukapheresis procedure to increase granulocyte harvest?

A

corticosteroids to move granulocytes into circulation

G-CSF to stimulate production of granulocytes

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23
Q

are granulocyte units crossmatched?

A

yes due to RBC contamination

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24
Q

are granulocytes leukoreduced?

A

no

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25
Q

are granulocytes irradiated?

A

yes

26
Q

granulocyte yield of leukapheresis

A

> 1x10^10

27
Q

leukapheresis storage

A

20-24C without agitation up to 24 hours after collection

28
Q

how long can granulocytes be stored after collection?

A

24 hours

29
Q

goal of therapeutic apheresis

A

treat certain conditions/diseases through removal of blood compnents/pathologic substances

30
Q

single blood volume therapeutic apheresis will get rid of what volume of pathologic substance?

A

two-thirds

31
Q

apheresis mode: removal of whole blood –> centrifuge –> plasma taken off and discarded –> red cells re-infused along with replacement fluid

A

manual

32
Q

apheresis mode: specialized device controls rate which blood is withdrawn, anticoagulation, separation, replacement fluids, and blood return. Separation occurs through centrifugation and filtration

A

automated

33
Q

apheresis mode: rotating channel, resulting in layers of plasma, platelets, leukocytes or red cells that can be removed selectively. removed component is diverted into separate bag; remaining components along with replacement fluid is re-infused back into patient

A

continuous flow

34
Q

apheresis mode: whole blood withdrawn, extracorporeal blood component processed, centrifugation, selected component taken off, remaining components along with replacement fluid re-infused back into patient

A

intermittent centrifugation

35
Q

apheresis mode: continuous flow operation; whole blood processed through microporous filter, plasma passes through, red cells retained. hollow filtration used to wash/remove immunoglobulins

A

filtration device

36
Q

apheresis mode: whole blood passes through a medium of high affinity for specific components, effluent returned to patient

A

selective adorption

37
Q

most commonly used anticoagulant in apheresis

A

citrate

38
Q

why is calcium administered during apheresis return procedure?

A

citrate binds calcium and causes hypocalcemia

39
Q

category I indications for apheresis

A

apheresis is standard, primary therapy

40
Q

category II indication for apheresis

A

apheresis is acceptable, supportive therapy

41
Q

category III indication for apheresis

A

apheresis is not well established, individualized therapy

42
Q

category IV indication for apheresis

A

apheresis is ineffective or harmful

43
Q

main indication for therapeutic plasma exchange

A

hyperviscosity

44
Q

disease states associated with hyperviscosity needing TPE

A

TTP, Waldenstrom’s macroglobulinemia, Myasthenia gravis, Guillain-Barre, Goodpastures syndrome, solid organ transplant

45
Q

replacement fluids used with TPE

A

5% albumin, 5% albumin and normal saline, donor plasma, cryopoor plasma

46
Q

how many TPE procedures are usually required to remove 90% of IgG antibodies?

A

~5 procedures of 1.5 blood volumes

47
Q

how many TPE procedures are usually required to remove 90% of IgM antibody?

A

2-3

48
Q

rare blood disorder characterized by clotting in small blood vessels of the body resulting in low platelet count

A

thrombotic thrombocytopenic purpura

49
Q

TTP pentad of symptoms

A 
microangiopathic hemolytic anemia
thrombocytopenic purpura
neurologic abnormalities
fever
renal disease
50
Q

mechanism of TTP

A

IgG antibody directed against ADAMTS13 enzyme

51
Q

what happens without ADAMTS13 in TTP?

A

large multimers of vWF accumulate and cause red blood cell hemolysis, thrombocytopenia, and organ damage

52
Q

indications for red cell exchange

A

sickle cell, hereditary hemochromatosis, polycythemia vera, babesiosis, severe malaria

53
Q

most common use of red cell exchange

A

sickle cell patients experiencing acute crisis

54
Q

most common indication for leukapheresis

A

hyperviscosity in acute leukemia

55
Q

specialized procedure in which buffy coat layer of blood is collected from whole blood, treated with 8-methoxypsoralen, exposed to UV light, reinfused back into patient

A

photopheresis

56
Q

effect of photopheresis

A

causes crosslinking of leukocyte DNA preventing replication and induces apoptosis

57
Q

indications for photopheresis

A 
cardiac allograft rejection
lung allograft rejection
cutaneous T-cell lymphoma
GVHD
systemic fibrosis
pemphigus vulgaris
scleroderma
58
Q

indications for selective adsorption apheresis

A 
selective removal of LDL
refractory rheumatoid arthritis
polyneuropathies (IgG/IgA or IgM)
lupus (removal of anti-DNA)
myasthenia gravis
59
Q

reactions to therapeutic apheresis

A

tingling, hypotension, hives, nausea, shivering, flushing, fainting, vertigo, arrhythmia, abdominal pain, anaphylaxis

60
Q

most common adverse effect of apheresis

A

symptomatic hypocalcemia (perioral and digital paresthesias) from infusion of citrate with returned blood

61
Q

most common reaction with plasma replacement

A

allergic reactions

CCHS SBB (40 decks)

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