PLASMAPHERESIS

By

Dr.Mohamed Abd El Gawad

Nephrology Specialist at New Mansoura General Hospital

Agenda What is Plasmapheresis ? INDICATIONS FOR PLASMAPHERESISTECHNIQUESReplacement fluidVascular accessAnticoagulationRegimens of PEComplications

What is Plasmapheresis?

INDICATIONS FOR PLASMAPHERESIS

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

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

Serum Albumin

Serum Albumin : 4 g /dL 40 g /L

40 × 3 = 120 g /L

Electrolytes

Calcium: 10 ml of calcium gluconate solution per liter of

replacement solution

Potassium : 4 mmol of Potassium to each liter of

replacement solution

Vascular access

Standard central venous catheters

Arteriovenous(AV) fistula

Peripheral access through large-bore, short, intravenous cannulae

Anticoagulation1 - 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⇒

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.

Plasma volume

Plasma volume = ( 0.07 × Body Weight ) × ( 1 - Hct )

( 0.07 × 70 ) × ( 1 - .4 ) = 2.9 L

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.

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

Target molecule kinetics during therapeutic plasma exchange .

Mark E. Williams, and Rasheed A. Balogun CJASN doi:10.2215/CJN.04680513

©2013 by American Society of Nephrology

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