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Plasmapheresis.
This document discusses plasmapheresis, which is a process that separates plasma from the blood. It has several indications including autoimmune diseases and thrombotic thrombocytopenic purpura. There are two main techniques, centrifugal plasma separation and membrane plasma separation. Membrane plasma separation uses hollow fiber membranes to separate plasma while retaining blood cells. Plasmapheresis procedures typically exchange 1-1.5 plasma volumes and are often done daily or every other day for 5-10 days to deplete pathogenic molecules by 90%. Complications can include hypocalcemia if citrate is used as an anticoagulant or bleeding if higher doses of heparin are needed.
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Plasmapheresis.
- 1. PLASMAPHERESIS By Dr.Mohamed Abd ElGawad Nephrology Specialist at New Mansoura General Hospital
- 2. Agenda What isPlasmapheresis ? INDICATIONS FOR PLASMAPHERESIS TECHNIQUES Replacement fluid Vascular access Anticoagulation Regimens of PE Complications
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- 10. TECHNIQUES A: Centrifugal plasmaseparation : 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
- 14. 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
- 15. Plasma volume Plasma volume= ( 0.07 × Body Weight ) × ( 1 - Hct ) ( 0.07 × 70 ) × ( 1 - .4 ) = 2.9 L
- 18. Serum Albumin Serum Albumin: 4 g /dL 40 g /L 40 × 3 = 120 g /3L
- 19. Electrolytes Calcium: 10 ml ofcalcium gluconate solution per liter of replacement solution Potassium : 4 mmol of Potassium to each liter of replacement solution
- 20. Vascular access Standard centralvenous 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.
- 23. Regimens of PE? Volumeof exchange 1-1.5 plasma volume Frequency of procedures Duration of therapy
- 24. 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.
- 26. A singleplasma 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
- 27. Target molecule kineticsduring 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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