TOPIC 26: plasmapheresis

Question 1

what is plasmapheresis?

Answer 1

• technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation.
• the separated component can be returned after an extracorporeal treatment or replaced

Question 2

2 types of plasmapheresis- DONATION (4)

Answer 2

blood taken from a healthy donor–> separated into component parts–>during blood donation, the needed component is collected and the unused ones returned to the donor.
includes:
1)plasmapheresis(collecting fresh frozen plasma-FFP)
2)Erythorcytapheresis
3)plateletpheresis
4)leukapheresis

Question 3

2 types of plasmapheresis- THERAPY (5)

Answer 3

-INVASIVE PROCESS
-so only used when other means to control a particular disease have failed
-or if the symptoms are too severe to wait for the treatment to be effective
includes:
1)plasma exchange(removal of harmful substances such as toxins or autoantibodies from the plasma)
2)LDL apheresis (in familial hyperchol)
3)leukocytapheresis (leukemia)
4)thrombocytapheresis (essential thrombocytopenia&polyc.vera)
5)extracorporeal photopheresis ( GVHD)

Question 4

Therapeutic Plasma Exchange (TPA) used to remove(6):

Answer 4

1) autoantibodies( p-ANCA,c-ANCA,anti-GBM, AChR)
2) toxins
3) cytokine(SIRS)
4) Immune complexes(cryoglobulinemia)
5) lipids (LDL)
6) paraproteins (MM)

Question 5

TPA mechanism &effects

Answer 5

2 methods:

A) separation of cellular comp from plasma based on SIZE
B) based on DENSITY
(centrifuge)

• procedure takes 1.5-2 hrs
• normally 40-6-ml/kg plasma removed

effects:

1) 60-75% of macromolecules removed from blood
2) 90% of immunoglobulins removed in 5 consecutive TPEs
3) complement, enzymes, clotting factors are restituted within 24-48 hours
- the anticoagulation solution ACD-A is used to minimize the effect of the procedure on hemostasis
- also binds to ca2+ which needs to be substituted

Question 6

TPA prerequisites

Answer 6

1) laboratory:
- normal ion conc
- htc >20%
- hb> 80g/l
- plt >20G/l
2) BP 90-160/70-100
3) pulse 60-140 BPM
4) vascular access

Question 7

TPA complications(5) and indications(8)

Answer 7

complications:

1) paresthesia (hypocalcemia due to ACD-A)
2) hypotension (hypovolemia)
3) nausea and vomiting
4) urticaria and anaphylaxis (FFP)
5) bleeding/hematoma

indications:

1) ANCA-associated RPGN
2) goodpasture sy
3) FSGS
4) WALDENSTROM macroglobulinemia
5) TTP
6) APS
7) cryoglonulinemia
8) Myasthenia Gravis