Plasmapheresis

1. PLASMAPHERESIS
By
Dr.Mohamed Abd El Gawad
Nephrology Specialist at New Mansoura
General Hospital

2. Agenda
 What is Plasmapheresis ?
 INDICATIONS FOR PLASMAPHERESIS
TECHNIQUES
Replacement fluid
Vascular access
Anticoagulation
Regimens of PE
Complications

3. What is Plasmapheresis?

5. INDICATIONS FOR PLASMAPHERESIS

10. TECHNIQUES
A: Centrifugal plasma separation : blood cells
are separated during centrifugation , there
are two centrifugation methods Intermittent
flow device and continuous flow device
B: membrane plasma separation : plasma
separators use membranes with a molecular
weight 3 million

15. membrane plasma separation
 Uses highly permeable hollow fibers with membrane pores
of 0.2to 0.5 µm.
 The hollow fiber functions as a membrane, with the pore
size (0.2to 0.5 µm) allowing transport of plasma across the
membrane while retaining other blood components.
 PlasmaFlux filters contain the polysulfone-based
Plasmasulfone membrane, which has been designed to
minimise the activation of the patient’s immune system
during blood–-membrane interaction

18. Serum Albumin
Serum Albumin : 4 g /dL
40 g /L
40 × 3 = 120 g /L

19. Electrolytes
Calcium:
10 ml of calcium gluconate solution per liter
of replacement solution
Potassium :
4 mmol of Potassium to each liter of
replacement solution

20. Vascular access
Standard central venous catheters
 Arteriovenous(AV) fistula
 Peripheral access through large-bore, short,
intravenous cannulae

21. Anticoagulation
1 - Citrate
 IT is used for centrifugal plasma exchang.
 citrate has particular advantages in patients at higher
bleeding risk in view of its lack of systemic anticoagulant
actions.
 Citrate is rapidly metabolized by the liver (normal levels
within 4 hours).
Hepatic dysfunction severe hypocalcemia⇒

22. 2–Heparin
 Used for membrane plasma filtration
 Higher doses may be needed than in hemodialysis as a
result of increased losses during the procedure (heparin
is protein bound).
 Bolus doses of unfractionated heparin 2000 to 5000 U
are given initially, and then 500 to 2000 U/h.

24. Plasma volume
Plasma volume =
( 0.07 × Body Weight ) × ( 1 - Hct )
( 0.07 × 70 ) × ( 1 - .4 )
= 2.9 L

25. Frequancy of procedures
1- Daily plasma exchange
 Most effective in rapidly depleting total body load.
 Intensity of exchanges has no major effect on
outcomes except in hemolytic-uremic syndrome.
2- Alternate-day exchanges
 proven efficacy in antineutrophil cytoplasmic
antibody (ANCA)–associated diseases.

27.  A single plasma volume exchange will lower
plasma macromolecule levels by
approximately 60% .
 Five exchanges during 5 to 10 days will clear
90% of the total body Immunoglobulin

28. Target molecule kinetics during therapeutic plasma exchange.
Mark E. Williams, and Rasheed A. Balogun CJASN
doi:10.2215/CJN.04680513
©2013by American Society of Nephrology

32. THANK YOU