Plasma pheresis procedure presentation ppt

Plasma
pheresis
Faculty of nursing O6U
DR. GIHAN MOHAMMED
DR. HANY GIRGIS
Under Supervision : Prepared by :
Group B5
Academic year :
2024/2025

Objectives
At the end of this presentation the students will be able to:
 Define Plasma Pheresis and Its Purpose
 Differentiate Between Types of Plasma Pheresis
 Explain the Procedure and Its Requirements
 Identify Indications, Risks, and Benefits
 Highlight Advances in Plasma Pheresis Technology
 The role of nurse in plasma pheresis procedure

outlines
1) Introduction to Plasma Pheresis
2) Types of Plasma Pheresis
3) Procedure Overview
4) Role of the Nurse in Plasma Pheresis
5) Indications for Plasma Pheresis
6) Risks and Complications
7) Benefits of Plasma Pheresis
8) Advances and Technology in Plasma Pheresis
9) Conclusion
10)References

Introduction to
Plasma Pheresis
01
About plasma pheresis
Definition of plasma pheresis
The purpose of the plasma pheresis
A historical overview of its development

About plasma pheresis
Plasma Pheresis is a vital medical procedure
used to manage severe immune and blood
disorders by removing harmful substances like
autoantibodies or toxins from the plasma. It
has proven effective in treating conditions such
as Guillain-Barré Syndrome and Thrombotic
Thrombocytopenic Purpura. Advances in
technology and a collaborative medical
approach have enhanced its safety and
efficiency in clinical practice.

Definition of plasma pheresis
From the greek Plasma, something molded aphairesis,
taking away Is the removal and treatment of blood
from the body and return of components of blood(i.e
blood cells)to the body after extraction of plasma
.or
Plasmapheresis is a blood purification procedure used
to treat several autoimmune diseases. It is also known
as therapeutic plasma exchange.

The purpose of the plasma pheresis
Has been used extensively for over four
decades to treat a variety of renal
diseases
The procedure is frequently referred to as
"plasmapheresis" when a solution other than
plasma (e.g., isotonic saline) is used as
replacement fluid
Removal of large quantities of plasma (usually
2 to 5 L) from a patient and replacement by
either fresh-frozen or stored plasma

A historical overview of its development
Plasma Pheresis is a medical technique used to separate
plasma from blood for therapeutic purposes or to
remove disease-causing components. The technique
originated in the 1940s with the development of the first
blood separation device in the United States. It evolved
in the 1970s to include therapeutic applications, such as
treating autoimmune diseases and nerve inflammations,
and has since become a cornerstone of modern
medicine

Types of Plasma
Pheresis
02
Plasma installation
Therapeutic Plasma Exchange (TPE)
Plasma removal and replacement
Therapeutic Plasma Exchange (TPE):
Therapeutic applications.
Plasma Donation:Used in the production
of medicines and treatments

It is composed of water (up to 95% of its volume),
important dissolved proteins (6-8%) (such as
blood albumin, globulin, fibrinogen), glucose,
clotting factors, electrolytes (Na+, Ca+2, Mg+2,
HCO3-, Cl-, etc.), hormones, carbon dioxide
(plasma is the main transport medium for
secretory products), and oxygen. It plays a vital
role in the osmotic effect within the blood
vessels, maintaining the balance of electrolyte
concentration and protecting the body from
infection and other blood disorders.
Plasma installation

Therapeutic Plasma Exchange (TPE)
Plasma removal and replacement
Therapeutic Plasma Exchange is a medical
procedure used to remove and replace
plasma from the blood. During TPE, harmful
substances such as autoantibodies, toxins, or
abnormal proteins are removed, and the
plasma is replaced with a substitute like
donor plasma or albumin. This treatment is
commonly used for autoimmune diseases
and certain neurological or hematological
conditions.

Neurological
Conditions:
• It helps remove harmful
substances from the blood that
contribute to neurological
disorders, including:
1. Multiple sclerosis.
2. Chronic inflammatory
demyelinating polyneuropathy
Kidney Diseases
It is used to treat certain
kidney conditions, such as
rapidly progressive
glomerulonephritis, by
removing harmful antibodies
from the blood.
Toxin Removal
Plasma exchange is
sometimes used to
remove toxins or
poisons from the
blood, such as in
cases of specific
poisonings.
www.traditionalmedicine.com
Therapeutic Plasma Exchange (TPE):
Therapeutic applications

Plasma Donation:Used in the production
of medicines and treatments
1-Immunoglobulins: Used to
treat immune deficiencies and
autoimmune diseases.
Clotting
2-Factors: For patients with
hemophilia or other bleeding
disorders.
3-Albumin: To treat severe
burns, liver conditions, and
shock.
4- Antithrombin III: Prevents
blood clots in certain patients.
Production of Plasma-
Derived Medicines:
Donated plasma is vital for advancing medical research, including
vaccine development and novel treatments.
Plasma for Research and
Development:
Plasma-based therapies are
used in:
Critical Care: Treating shock,
trauma, and severe infections.
Autoimmune Diseases:
Managing conditions like
lupus and multiple sclerosis.
Neurological Disorders:
Supporting treatments for
diseases such as chronic
inflammatory demyelinating
polyneuropathy (CIDP).
Therapeutic Applications:

Procedure Overview
03
Preparation before the operation
How to perform the operation (device
used, steps)
Duration of the operation and patient
requirements

1
History: Evaluate overall health, chronic diseases (e.g., heart, kidney, liver), and
immune conditions or infections.
2
3
Catheter Placement : 1- Central Venous Catheter: Inserted into large veins (e.g.,
jugular or femoral) for efficient blood flow
2-Site Preparation: Ensure sterilization to prevent infection.
4
Plasma Replacement Evaluation : Choose replacement fluid:
1-Fresh Frozen Plasma (FFP) for protein deficiencies.
2-Saline/Albumin solutions to minimize immune reactions.
N.B : Check for allergies to replacement fluids.
5
Device Preparation:
1-Ensure proper function of the plasmapheresis device (centrifuge or filters)
2- Prepare monitoring systems for vital signs (blood pressure, heart rate, oxygen).
Lab Tests:
1- CBC to check blood cell levels.
2 - Kidney and liver function tests.
3-Coagulation tests (PT/INR, aPTT)
4- Blood typing to ensure compatibility for plasma replacement.
5-Antibody screening for autoimmune conditions.

6
Dietary Preparation:
1- Fasting: Avoid food and drink 4–6 hours prior to the procedure.
2- Hydration: Stay well-hydrated the day before.
7
Medication Adjustments :
1- Stop anticoagulants (e.g., aspirin, warfarin) to reduce bleeding risks.
2- Administer sedatives if needed for patient comfort.
8
Patient Education :
1-Explain procedure steps, duration (2–3 hours), benefits, and risks.
2- Provide post-procedure care instructions (e.g., rest, hydration).
9
Qualified Medical Team:
1-Ensure the presence of an experienced physician and trained nursing staff.
2- Proper preparation ensures safety and maximizes the success of plasmapheresis.

How to perform the operation (device used, steps)
Separate blood components
based on their density.
Used for therapeutic
plasma exchange (TPE) to
remove plasma and retain
other blood components.
Centrifugation-based devices: Column-based devices:
Utilize special adsorption
columns to filter out harmful
substances (e.g., antibodies,
toxins).
Techniques include filtration,
ligand binding, or chemical
precipitation.
Extracorporeal
Photopheresis devices
Focus on isolating and
treating white blood cells
but can be part of
plasmapheresis for
certain conditions.

Insert a catheter or use a vein
for blood withdrawal and
reinfusion.
Venous access placement:
Prevent clotting during
the procedure using
citrate or heparin.
Anticoagulant
administration
The patient is monitored for
complications like
hypotension or electrolyte
imbalances during and after
the procedure.
Monitoring
The extracted plasma may be
discarded, treated, or replaced
with donor plasma, saline, or
albumin.
Plasma is separated using
centrifugation or column-based
filtration devices.
Blood separation
Plasma removal or
treatment
Reinfusion
The remaining blood
components (red and white
blood cells, platelets) are
returned to the patient.

Duration of the operation and
patient requirements
Duration
A plasma separation session usually takes between
1.5 to 3 hours, depending on the patient's condition
and the volume of blood being treated.
During the procedure
1-A catheter is placed in a vein
(in the hand or neck) to withdraw
blood and return it after
separating the plasma
2-A special device is used to
separate the plasma from the rest
of the blood components.
3-The plasma is replaced with
saline solution, or donor plasma
Monitoring during the session
1-Blood pressure, heart rate, and
oxygen level are monitored
throughout the procedure.
2- The patient may feel some
symptoms such as nausea or
dizziness due to changes in fluid
volume.
Post-operative care
1-Rest for a few hours
2- Drink enough fluids
to replace lost fluids.
3- Monitor symptoms
such as fatigue or
bleeding at the catheter
site

Role of the Nurse in Plasma Pheresis
04
Role of the Nurse in Plasma Pheresis:
Pre-procedure Responsibilities
During the Procedure
Post-procedure Responsibilities

Check the patient’s health
status (check vital signs)
1- Health Assessment and vital Monitoring for plasma
pheresis .
2- Before: Review medical history, conduct blood tests, and
assess vital signs.
3- During: Monitor vital signs, maintain fluid balance, and
check for allergic reactions
4- After: Test protein levels, check for side effects, and
schedule follow-ups.
5- Recommendation: Conduct in a specialized, well-
equipped facility.

Role
of
the
Nurse
in
Plasma
Pheresis:
Pre-procedure
Responsibilities
Prepare the patient (check veins and apply catheter if necessary)
:
Patient Assessment and Preparation
• Assess vital signs, medical history, medications, and allergies.
• Explain the procedure, address concerns, and obtain informed consent.
1
Equipment and Setup:
• Ensure functionality of plasmapheresis equipment and availability of
anticoagulants/replacement fluids.
• Prepare vascular access devices as needed.
2
:
Patient Education and Support
• Educate on the procedure’s purpose, risks, and duration.
• Provide emotional support to alleviate anxiety.
3
:
Medication Administration
• Administer prescribed pre-medications (e.g., antihistamines, corticosteroids).
4
Infection Control :
• Use strict aseptic techniques for equipment and vascular access.
5
Monitoring and Documentation:
• Record baseline vital signs, weight, and fluid status
6

Patient Monitoring: Observe
vital signs and symptoms
such as dizziness or tingling.
Machine Management: Operate
the plasmapheresis machine
and ensure proper functionality.
Support and
Coordination:
Collaborate with the
medical team and
provide emotional
support to the
patient.
Complication Prevention: Monitor
for and address complications like
hypocalcemia or hypotension
while maintaining aseptic
techniques.
Communication and
Documentation: Reassure the
patient and document
responses, interventions, and
fluids administered.
During procedure Responsibilities
Monitor vital signs throughout the procedure

During the Procedure
Ensure that the devices are working properly
Catheterization:
• More than the required limit causes
bleeding or perforation depending
on the insertion site.
• Longer than necessary causes
infection.
• The presence of blood outside the
human body while passing through
the plasma separation device may
cause blood clotting and this can
be avoided by giving (sodium
stearate).
Quick identification of any complications
Low blood pressure:
• General weakness in the body
• Blurry vision
• Dizziness
• Feeling cold
Reaction to the transfused blood
An adverse reaction may occur when
the immune system does not recognize
the blood, which leads to it attacking
the blood as a foreign body

Monitoring Vital Signs:
Regularly check blood pressure, heart rate, and
oxygen levels to detect any signs of
complications like hypotension or arrhythmias.
Site Care: If a central line or catheter was used, inspect the site for signs
of infection, bleeding, or thrombosis.
Observation for
Adverse Effects:
Look for symptoms such as dizziness, muscle cramps,
or allergic reactions to the replacement fluids used
during the procedure.
Assessing the patient’s condition after the operation
Record any notes about reactions or complications

Monitor for signs of dehydration or fluid overload, as the
procedure can alter plasma volume.
Encourage hydration and balanced nutrition to help
replenish the body after plasma removal and
replacement.
Fluid Balance:
Nutritional Support:
Patient Education:
Inform patients about the potential for fatigue and the
need to avoid strenuous activities for a day or two after
the procedure.
www.traditionalmedicine.com
Assessing the patient’s condition after the operation
Record any notes about reactions or complications

Educating the patient about
the procedure and answering
his questions
1- Removes harmful plasma and replaces it with a solution
or healthy plasma to treat autoimmune and chronic
conditions.
2- Procedure lasts 2-4 hours
3- Requires blood tests and possible medication
adjustments
4- Benefits include symptom relief; risks involve low blood
pressure or reactions
5- post-procedure instructions : Stay hydrated, follow up
with tests, and report issues.

Providing home care
instructions and follow-up
Hydration
Encourage the patient to drink
plenty of fluids to replenish the
volume removed during the
procedure.
Hydration
Recommend avoiding alcohol
and caffeine for 24-48 hours as
they can cause dehydration.
Diet
Advise eating a balanced diet
rich in proteins and vitamins to
promote recovery.
Physical Activity
Recommend resting for 24
hours post-procedure.
Physical Activity
Advise against heavy lifting,
vigorous exercise, or any
strenuous activity for at least 48
hours.
Monitoring for Side Effects
Provide guidance on what to do
if they experience bleeding or
swelling at the venipuncture
site.
Monitoring for Side Effects
Instruct the patient to monitor for
symptoms such as dizziness, fatigue,
or tingling sensations in the
Care of the Venipuncture Site
Keep the site clean and dry for
24-48 hours.
Care of the Venipuncture Site
Avoid soaking the area in water
(e.g., swimming or bathing) until
it has fully healed.

Indications for Plasma Pheresis
05
Autoimmune diseases such as
(Guillain - Barré Syndrome, Myasthenia Gravis)
Blood diseases such as
(Thrombotic Thrombocytopenic Purpura – TTP)
-Neurological diseases and chronic infections

Autoimmune diseases such as
(Guillain - Barré Syndrome, Myasthenia Gravis)
Myasthenia Gravis:
Used during myasthenic crises or in cases of severe symptoms to
remove circulating antibodies against acetylcholine receptors.
Guillain-Barré Syndrome:
Helps accelerate recovery by removing autoantibodies attacking
the peripheral nerves.
.
Polymyositis and Dermatomyositis:
Inflammatory muscle disorders with an autoimmune basis.
Vasculitis:
Such as ANCA-associated vasculitis or cryoglobulinemia, where
plasmapheresis removes pathogenic antibodies or immune
complexes.

Hematologic Diseases (Blood Disorder):
That means any condition that affects the components of blood
such as red blood cells, white blood cells, platelets or plasma.
Thrombotic Thrombocytopenic Purpura (TTP)
1-It is a rare hematological disorder characterized by widespread
microvascular thrombosis due to a severe deficiency in the
( ADAMTS13 enzyme ) , Which cleaves von Willebrand factor
multimers .
2-One of the methods of treatments is Plasma Exchange Therapy:
The first-line treatment to remove autoantibodies and replenish
ADAMTS13 levels
Blood diseases such as
(Thrombotic Thrombocytopenic Purpura – TTP)

-Neurological diseases and chronic infections
Neurological diseases and chronic infections :
1. Multiple Sclerosis (MS): used for acute severe relapses.
2. Autoimmune Encephalitis: used for antibody-mediated
forms, reducing neuroinflammation and autoantibodies.
3. Chronic inflammatory demyelinating polyneuropathy
(CIDP): used in cases when corticosteroids or IV
immunoglobulin fail to control symptoms
Role in chronic inflammatory disorder:
Plasmapheresis is useful for reducing immune-
mediated damage in chronic inflammatory diseases, its
effects are temporary, and it necessitates repeated
sessions.

Risks and Complications
06
Infection or allergic reactions
Imbalance in blood components
Low blood pressure.

Infection or allergic reactions
When a person is exposed to a cause in
the system, the immune system
recognizes it to become a safe product,
and by secreting antibodies quickly, they
work to deliver a message to the cells to
stop that substance, sending histamine
cells, which causes the blood vessels to
dilate, in addition to other chemicals to
cause allergy symptoms to appear.

Imbalance in blood components
An increase in blood components, such
as red blood cells, immune system
proteins, or platelets, can thicken the
blood, leading to symptoms like
headaches, shortness of breath, and
dizziness. This condition, known as
hyperviscosity syndrome, reduces blood
flow in small vessels and may occur in
disorders like multiple myeloma. It can
result in serious complications, including
thrombosis and reduced oxygen delivery
to tissues.

Shock
Severe reactions, including
anaphylaxis, can result in
shock and profound
hypotension.
Sepsis or
Infection:
Rarely, contaminated
equipment or fluids may
introduce infection, causing
systemic hypotension.
Underlying
Cardiovascular
Instability:
Patients with preexisting
cardiovascular issues may not
tolerate the rapid fluid shifts
associated with plasmapheresis.
Allergic Reaction:
Sensitivity to replacement fluids
or anticoagulants can cause an
anaphylactoid reaction, leading
to hypotension.
Low blood pressure.

Benefits of Plasma Pheresis
07
Improving symptoms in many
medical conditions
Reducing antibodies and
toxins in the blood.

Improving symptoms in many medical
conditions
Autoimmune Diseases
Mechanism:
Removes harmful antibodies from
the bloodstream to prevent them
from attacking the body's own
tissues. Does not stop the immune
system from producing new
antibodies, so benefits are
temporary.
Example Conditions:
Guillain-Barré Syndrome (GBS): Reduces
inflammation and nerve damage, improving
muscle strength and sensation. Myasthenia
Gravis: Clears antibodies causing muscle
weakness, fatigue, and respiratory problems.
Neurological Disorders
Mechanism:
Removes inflammatory mediators to
reduce symptoms in nervous system
diseases.
Example Condition:
Multiple Sclerosis (MS): During acute
relapses, it removes inflammatory
cytokines and immune cells, alleviating
symptoms like vision loss, paralysis, and
numbness.

Improving symptoms in many medical
conditions
Preparation for Transplant
Mechanism:
Removes antibodies that may
cause organ rejection.
Example Conditions:
Reduces the risk of organ rejection in
patients with high levels of HLA antibodies..
Blood Disorders
Mechanism:
Mechanism: Clears abnormal proteins or
excess blood components that disrupt
normal circulation.
Example Condition:
Thrombotic Thrombocytopenic Purpura
(TTP): Removes autoantibodies and abnormal
proteins to reduce microclots, restore platelet
levels, and improve symptoms like confusion,
fatigue, or bleeding.
Hyperviscosity Syndrome: Reduces excess
paraproteins to improve blood flow and
relieve symptoms such as headaches, vision
problems, and dizziness.

Reducing antibodies and toxins in
the blood.
Benefits of plasma separation:
1-Removal of harmful antibodies from the
blood To alleviate the symptoms of
immune diseases
2- Remove immune toxins, and may
reduce inflammation and prevent organ
damage
3-The process of plasma separation helps
in conditions such as lupus and angitis

Advances and Technology in
Plasma Pheresis
08
Modern devices used
Innovations in plasma
replacement technologies

Modern devices used
Octonova (Asahi Kasei)
Uses advanced membrane
technology to ensure high
purity
Advantages:
1-Lower risk of clogging.
2-Higher productivity compared
to older membrane systems.
Cobe Spectra (Terumo BCT)
Widely used for plasma
exchange and all blood
cell treatments
Advantages:‫ـ‬
1-High accuracy.
2-Minimal loss of other
blood components.
Prismaflex (Baxter)
Designed for therapeutic
plasma exchange in a compact
size.
Advantages:
Small size for easy mobility in
hospitals.

1) Plasmapheresis began on animals
2) Then on some people but without systematic study
3) Then the first systematic study of plasmapheresis
4) then treat an immune disorder with the
plasmapheresis technique
5) then it be able to separate plasma automatically
rather than manual
6) then we use the modern centrifugation
7) then integrated devices with control screens
Innovations in plasma
replacement technologies

Conclusion
06
Summary of main points
The importance of Plasma Pheresis
in modern medicine
The role of the medical team in the
success of the operation.

Plasmapheresis Overview: First described in 1913 by
Vadim A. Yurevick and Nicolay Rosenberg, and in 1914 by
John Abel and Leonard Rowntree.
Procedure: A machine separates plasma from blood cells to
remove harmful substances like antibodies, abnormal proteins, or
toxins..
Applications: Used as a therapeutic tool for various
conditions, particularly when plasma contains acutely
toxic substances..
Treated Conditions: Includes neurologic, hematologic,
metabolic, dermatologic, rheumatologic, renal diseases, and
cases of intoxication.
Summary of main points

The importance of Plasma Pheresis
in modern medicine
1. Removes harmful substances (toxins,
antibodies) from the blood.
2. Treats autoimmune and neurological
disorders.
3. Supports recovery in life-threatening
conditions.
4. Enhances the effectiveness of other medical
treatments.
5. Improves patient outcomes in chronic and
acute diseases.

Accurate Assessment
and Diagnosis
Patient
Education
Thorough
Preparation
Continuous
Monitoring
Managing
Complications
The role of the medical team in the
success of the operation.
Team Coordination
Post-Procedure Care

References
10
• Journal of Clinical Apheresis, Vol.15, No.1/2, 2000, Special
Issue, Clinical Applications of Therapeutic Apheresis
• APHERESIS, Principles and Practice, 2nd Edition, Bruce
McLeod Editor, AABB Press 2003
• P.M. Reimann and P.D. Mason, Plasmapheresis: technique and
complications, Intensive Care Med (1990) 16:3-10
• Bernd G. Stegmayr, A survey of blood purification techniques,
Transfusion and Apheresis Science 32 (2005) 209-220
• Journal of Clinical Apheresis 2000- 2006
• Hematology: Basic Principles and Practice
• Therapeutic Apheresis: A Physician's Handbook
• Critical Care Nursing
• Travis J. McKenzie, M.D., 1 Joseph B. Lillegard, M.D., Ph.D., 1
and Scott L. Nyberg, M.D., Ph.D., Artificial and Bioartificial Liver
Support, SEMINARS IN LIVER DISEASE/VOLUME 28, NUMBER 2
2008

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