apheresis procedures

7/23/2019 Apheresis Procedures

1/34

1

Apheresis Procedures


2/34

16.02.04 Dr. M. Susca 2/34

From greek Apheresis, i.e. separationof plasma through membran lter orcentrifuge

Defnition


3/34

16.02.04 Dr. M. Susca 3/34

Plasmapheresis

Preparative PlasmapheresisT

herapeutic Plasmapheresis

lood !ells

Plasma Fractions

!onserved Plasma

selective

semi"selective

non"selective


4/34

16.02.04 Dr. M. Susca 4/34

Overview

Plasmapheresis

Preparative Plasmapheresis Therapeutic Plasmapheresis

!onserved Plasma

Plasma Protein !oncentrate

Fresh"fro#en"Plasma $FFP%

Plasma Fractions

!oagulation Factors

&uman Albumine

lood cells

'eucoc(te !oncentrates

)r(throc(te !oncentrate

Thromboc(te !oncentrate

non"selective

Therapeutic Plasma )*change

Activated !harcoal Adsorption

+on )*change Adsorption

semi"selective

!ascade Filtration

!r(o Filtration

+mmuno Adsorption

Phen(lalanin

Tr(ptophan

selective

)n#(m Adsorption $ioreaction%

+mmuno Adsorption

''"Apheresis

Protein A

&eparin Pre#ipitation

e*transulfat Adsorption

+mmuno Adsorption

Thermo Filtration $-%


5/34

16.02.04 Dr. M. Susca 5/34

Therapeutic Plasmapheresis

non"selective

+on )*change Adsorption

Activated charcoal Adsorption

Plasma )*change

semi"selective

!ascade Filtration

!r(o"Filtration

+mmuno"Adsorption

Phen(lalanin

Tr(ptophan

selective

)n#(m Adsorption $ioreaction%

+mmuno"Adsorption

''"Apheresis

Protein A

&eparin Pre#ipitation

e*transulfat Adsorption

+mmuno"Adsorption

Thermo"Filtration $-%


6/34

16.02.04 Dr. M. Susca 6/34

+mmuno"Adsorption

e*transulfat Adsorption!ascade Filtration!r(o"Filtration

&eparin PrecipitationTherapeuticPlasma )*change


7/34

16.02.04 Dr. M. Susca 7/34


8/34

16.02.04 Dr. M. Susca 8/34

!ut"o / 0ioa

0aterialPol(prop(lenPol(sulfon

!ellulosediacetat

2urface 3.1/"3.4 m5

Pore 2i#e 3.6"3.4 7m

2terilisation)T82team9amma

2ieving !oe:cient ;3.1?/ of lood Flo@ =ate

T0P >133 mm&g

2econdar( 0embrane

&emocompatibilit(

Membrane Filter Separation


9/34

16.02.04 Dr. M. Susca 9/34

Thromboc(tes 6"/. 7m

Albumine 4B ka

+g9 13 ka

+gA 143 ka

+g0 B33 ka

Fibrinogen /C3 ka

'' 6333"C33 ka

3.36 7m 0embrane Pores 3.6"3.4 7m


10/34

16.02.04 Dr. M. Susca 10/34

Plasma Component Sieving Coefcient

Total Protein 3.BAlbumine 3.B

+g9 3.B

+gA 3.


11/34

16.02.04 Dr. M. Susca 11/34

optimal plasma separation

1. plasma?blood Do@ 1?/6. lo@ T0P

/. high blood Do@


12/34

16.02.04 Dr. M. Susca 12/34

Advantages

rel. simple technic

bride spectrum ofindication

rel. lo@costs

Disadvantages

non"selective

substitutioncomplications

no chronicapplication

&eparin

V

V

PV

PA

Pl. S

BLD

SAD

&eater

Pla

smaFil te

r

PPL

SAC

Balance

TPE - Terape!tic Plasma E"cange


13/34

16.02.04 Dr. M. Susca 13/34

E. ugularisinternaE.subclavia

E.cubitalis

E.femoralis

#essel Access

periferal vein

arterio"venous stula

central"venous access

!imino Fistula

$lood Access


14/34

16.02.04 Dr. M. Susca 14/34

Anticoag!lation


15/34

16.02.04 Dr. M. Susca 15/34

efect +nur(G

)ndogen 2(stem )*ogen 2(stem

)ndothel Tissue

Tissue Factor $+++% H!a6H $+E% H E++

G++ G+ +G

G++a G+a +Ga

E+++!a6H$+E%

TF/

TF/H

Ga H E H !a6H$+E%

Thromboc(tes

Prothrombin $++%G+++

Fibrinogen $+%Fibrin 0onmers

G+++a

Fibrin

&eparin

AT +++

!itrate

Coag!lation Cascade

Thrombin


16/34

16.02.04 Dr. M. Susca 16/34

S!bstit!tion

Iisovolemic, isotonic, isooncotic

Iallergen and p(rogen free, sterile

Icontaining coagulation factors andimmunoglobulins

Clinical%e&!irement


17/34

16.02.04 Dr. M. Susca 17/34

S!bstit!tion

%emarcs

1.

Plasma )*pander e*trane, &(dro*(eth(lstarch $&)2%, 9elatine Preparation. 2hort&alf 'ife Time

6.

!onserved PlasmaProtein

!ontain )Jl(tes, Albumine, 9lobulins. )*pensive, +ncompatibilit(=eactions

/.

Fresh Fro#en Plasma$FFP%

A3"!ompatibilit(, +ndikation for TTP und 9oodpasture"2(ndrom,Allergic =eactions, Eiral +nfections, &(pocalcemia

C.

&uman Albumine

2olution

Albumine H &emoltration 2olutions @ith 'actate or icarbonate,'o@ =ate of 2ide )ects


18/34

16.02.04 Dr. M. Susca 18/34

'a(mmol)l

*(mmol)l

Ca+(mmol)l

Mg+(mmol)l

Cl-mmol)l

,actatemmol)l

l!coseg)l

Osmol.mmol)l

1/"13 3"C 1.4"6.3 3.3"3.K 133"11/ /"C 3"6.3 6


19/34

16.02.04 Dr. M. Susca 19/34

/!man Alb!mine Electrol0te Sol!tion

12

Sol!tion

1.32

Sol!tion

42

Sol!tion

4.32

Sol!tion

32

Sol!tion

3.32

Sol!tion

52

Sol!tion

&F"2olution $ml%


20/34

16.02.04 Dr. M. Susca 20/34

Albumine

&F 2olution

i.g. 6 'iters CL"2olution M C33 ml Albumine 63L H 1433 ml &F 2olution

Alb!mine Sol!tion


21/34

16.02.04 Dr. M. Susca 21/34

E"cange #ol!me

Plasma Eolume N " 6 PE

=atio 11

Therap( Time 1 O / hFreuenc( acute 1* da( for / da(s lang, then ever( 6 da(s

chronic 1"C monthl(


22/34

16.02.04 Dr. M. Susca 22/34


23/34

16.02.04 Dr. M. Susca 23/34

Dil!tion *inetics


24/34

16.02.04 Dr. M. Susca 24/34

+ntracellular 2pace M C3L

)*tracellular 2pace M 63L

+nterstitial 2pace M 14L

+ntravascular 2pace M CL


25/34

16.02.04 Dr. M. Susca 25/34

Distrib!tion #ol!me

Plasma Component Mole6!lar 7eigtDalton

8ntrav. Distrib!tion2

/al9 ,i9e TimeDa0s

'ormal val!eg)l

Albumine 4B 333 C3 1B /"3

+g9 13 333 3 63"6/


26/34

16.02.04 Dr. M. Susca 26/34

Complications

tecnical medical

Access Problems &(potension

Plasma Filter !lotting Allerg(

lood 'eak Fever

&emol(sis &(pocalcemia

Arrh(thmia

)dema


27/34

16.02.04 Dr. M. Susca 27/34

8ndications


28/34

16.02.04 Dr. M. Susca 28/34

%emind

1.Plasmapheresis is often a s(mptomatictherap(

6.Plasmapheresis can cause a =ebound")ect b( res(nthesis andredistribution of pathogens

/.Therefore plasmapheresis is regular(accompanied b( an immuno"

suppressive or c(tostatic therap(


29/34

16.02.04 Dr. M. Susca 29/34

Cascade Filtration

&eater

&eparin

V

V

PV

PA

BLD

SADPl

asmaFil te

r

PPL

SACCascadeF

ilter


30/34

16.02.04 Dr. M. Susca 30/34

Cascade Filtration :Dead;End-Proced!re

&eparin

V

V

PV

PA

BLD

SAD

&eater

PlasmaFil te

r

PPL

SAC

Plasma

Adsorber

Regeneration

Solution

Particle Filter

apheresis procedures

Documents