Therapeutic apheresis Flashcards
1
Q
Categories of therapeutic apheresis
A
- Category I
- marked leukocytosis with leukostasis (cytapheresis)
- SCD, acute stroke
- apheresis is standard and acceptable as a primary therapy or firstline adjunct therapy
- is not mandatory in all cases
- Category II
- SCD, acute chest, stroke prophylaxis or prevention of iron overload
- thrombocytosis, symptomatic
- apheresis is generally accepted but considered tobe supportive or adjunctive to other treatments rather than a first line treatment
- Category III
- Heart transplantation antibody mediated rejection, acute hepatic failure, posttransfusion purpura, chronic progressive MS
- apheresis may be beneficial, however there is insufficient evidence to establish the efficacy or to clarify the risk or benefit
- Category IV
- ITP, HUS, SLE nephritis
- Controlled trials have not shown benefit, or anecdotal reports have been discouraging
- apheresis for these disorders should be carried out only in the context of an IRB approved research protocol
2
Q
Category I apheresis indications
A
- marked leukocytosis
- SCD, acute stroke
- Acute inflammatory demyelinating polyneuropathy (Guillain-Barre)
- ANCA associated rapidly progressive GN
- Antiglomular basement membrane disease (Goodpasture)
- CIDP
- Cryoglobulinemia: severe or symptomatic
- FSGS, recurrent
- Hyperviscosity 2/2 monoclonal gammopathy (especially IgM)
- MG
- Paraproteinemic polyneuropathies
- Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and Sydenham chorea
- Renal transplantation, antibody mediated rejection
- TTP
3
Q
Category II apheresis indications
A
- SCD, acute chest, stroke prophylaxis or prevention of iron overload
- symptomatic thrombocytosis
- SLE: cerebritis, diffuse alveolar hemorrhage
- Renal transplantation: HLA desensitization or ABO incompatible transplant
- Catastrophic antiphospholipid syndrome
- chronic focal encephalitis (Rasmussen encephalitis)
- MS: acute CNS inflammatory demyelinating disease refractory to steroids
- Mushroom poisoning
- Phytanic acid storage disease (Refsum disease)
- Neuromyelitis optica (Devic syndrome)
4
Q
apheresis replacement fluids
A
- normal saline
- 5% albumin
- allogeneic plasma (FFP or cryo poor FFP) in TTP
5
Q
Medication interactions with apheresis
A
- highly protein bound meds or meds with low volume of distribution (vd<0.2 L/kg) may be removed
- dosing immediately after apheresis should be considered
- ACE inhibitors should be d/c’d 24 hours prior to apheresis since they can cause hypotension