Nadia, tpe

3. Apheresis (ἀφαίρεσις (aphairesis, "a taking away"))
Plasmapheresis:
Plasma (from the Greek πλάσμα—plasma, something
molded, and ἀφαίρεσις—aphairesis, taking away) is the
removal, treatment, and return or exchange of blood
plasma or components from and to the blood circulation.
It is thus an extracorporeal therapy

4. The term apheresis emerged in 1914 when John J. Abel, of the
Johns Hopkins University Pharmacological Laboratory,
demonstrated how large quantities of plasma could be removed
from dogs by a process he called “plasmapheresis”).
separation technology first refined by Edwin Cohn's protein
scientist. was responsible for the blood fractionation project that
saved thousands of lives in World War II.(1945) centrifuge
marketed in 1953
The treatment, by manual plasmapheresis, of hyperviscosity
syndrome in patients with Waldenström macroglobulinemia
during the 1950s.
Kenneth Kaushansky, Marshall A. Lichtman, Josef T. Prchal, Marcel M. L
evi, Oliver W. Press, Linda J. Burns, Michael Caligiuri

5. Michael Rubinstein was the first person to use plasmapheresis to
treat an immune-related disorder when he "saved the life of an
adolescent boy with thrombotic thrombocytopenic purpura (TTP) at
the old Cedars of Lebanon Hospital in Los Angeles in 1959".
The modern plasmapheresis process itself originated in the "[U.S.]
National Cancer Institute between 1963 and 1968
."Wallace, D. J. "Apheresis for lupus erythematosus". Lupus (1
999) 8, 174–180.

7. Title
Apheresis; Donation and therapeutic

8. Donation
• Plasmapheresis – blood plasma. useful in collecting FFP (fresh frozen
plasma) of a particular ABO group. other uses include immunoglobulin
products,
• Erythrocytapheresis –is the separation of erythrocytes from whole
blood. This process is used for red blood cell diseases such as sickle
cell crises or severe malaria.
• Plateletpheresis (thrombapheresis, thrombocytapheresis) –
• Leukapheresis –is the removal of PMNs, basophils, eosinophils for
transfusion into patients whose PMNs are ineffective
• Stem cell harvesting – circulating bone marrow cells are
harvested to use in bone marrow transplantation.

9. Therapy
The various apheresis techniques may be used whenever the removed
constituent is causing severe symptoms of disease.
• Plasma exchange – removal of the liquid portion of blood to remove
harmful substances. The plasma is replaced with a replacement solution.
• LDL apheresis – removal of low density lipoprotein in patients with
familial hypercholesterolemia.
• Leukocytapheresis – removal of malignant white blood cells in people
with Acute leukemia and very high white blood cell counts > 100.000
causing symptoms.
• Erythrocytapheresis : sickle cell anemia crisis, Malaria
• Thrombocytapheresis– essential thrombocythemia or
polycythemia vera.

10. Title
TPE ( Therapeutic plasma exchange)

11. extracorporeal removal of large
molecular wt substances from
plasma including
• pathogenic antibodies
• cryoglobulins
• lipoproteins

12. Autoantibodies, allo-antibodies, paraproteins, endogenous toxins

14. • No upper limit
• Platelet ↓ 50%

16. Multifiltrate machine

17. Immuneadsorption

18. Duoble filtration plasmapheresis

19. Indications
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24. Indications
in kidney disease
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25. Crescentic GN (RPGN)
• Post infectious GN, GN+ IE
• IgA nephropathy
• MPGN
• membranous

26. ADAMTS13 – TTP-HUS
FFP

27. Good Pasture Syndrome
• Effective after 7-10 plasma volume exchanges
• Pulmonary hemorrhage is an independent indication

28. Lupus nephritis
• No benefit of PLEX over conventional immunosuppression.
• Crescentic GN
• Pulmonary hge
• Lupus cerebritis
• Catastrphic antiphospholipid syndrome
• Lupus associated TTP
• Unresponsiveness to conventional ttt
• Cytotoxic side effects ( BM depression)

29. Contraindications
• Patients who cannot tolerate central line placement
• Patients who are actively septic or are hemodynamic
ally unstable
• Patients who have allergies to fresh frozen plasma or
albumin depending on the type of plasma exchange
• Patients with heparin allergies should not receive hep
arin as an anticoagulant during plasmapheresis
• Patients with hypocalcemia are at risk for worsening o
f their condition because citrate is commonly used to
prevent clotting and can potentiate hypocalcemia

30. Procedure
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• Vacular access
• Dose and duration
• Plasma removal
• Replacement fluid
• Monitroring
• Complications, during and post

32. Volume of plasma removed
• Typically, 30–40 mL/kg of plasma are removed at each pro
cedure and replaced with isotonic ,human albumin solution
Estimation of plasma volume:
• estimated plasma volume is
Plasma Volume =
( 0.07 × Body Weight ) × ( 1 - Hct )
( 0.07 × 70 ) × ( 1 – 0.4 )
= 2.9 L

37. Dose and duration
• A one plasma volume exchange removes about 66% of an
intravascular constituent and a two plasma volume
exchange approximately 85%.
• Five exchanges during 5 to 10 days will clear 90% of the
total body Immunoglobulin
• Daily plasma exchange
Most effective in rapidly depleting total body load.
Intensity of exchanges has no major effect on outcomes excep
t in hemolytic-uremic syndrome.
• Alternate-day exchanges
proven efficacy in antineutrophil cytoplasmic antibody (ANCA)
–associated diseases.

40. Complications
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41. Risks associated with therapeutic plasma exchange
• Plasma exchange with albumin or saline causes a transient
fall in blood-clotting factors and mild prolongation of
prothrombin and activated partial thromboplastin times
recovering in 4 to 24 hours.
• Clinically significant bleeding is rare but a coagulation
screen should be undertaken before surgery or organ biops
y is performed.
• Other risks include haematomas at venepuncture/line inse
rtion sites, vasovagal episodes with fainting, fluid overlo
ad or under-replacement, and allergic or anaphylactic r
eaction due to plasma infusion.

43. For a single session PET 23 y old male patient presented with GB ,TBW: 70kg,Hct: .4
• Volume of plasma removed:
• Albumin:
• Plasma:
• Saline:
• Ca amp:
• K amp :
0.07 × BW (1 - HCT)
2.94L (3L)
12 bottle 20% ( 120gm)
12 unit
1000-1500 ml
(30 mmol/L)
1.5 amp (15 mmol/L)

44. Title