Post on 14-Feb-2018
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Apheresis Procedures
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From greek Apheresis, i.e. separationof plasma through membran lter orcentrifuge
Defnition
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Plasmapheresis
Preparative PlasmapheresisT
herapeutic Plasmapheresis
lood !ells
Plasma Fractions
!onserved Plasma
selective
semi"selective
non"selective
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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 $-%
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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 $-%
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+mmuno"Adsorption
e*transulfat Adsorption!ascade Filtration!r(o"Filtration
&eparin PrecipitationTherapeuticPlasma )*change
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!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
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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
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Plasma Component Sieving Coefcient
Total Protein 3.BAlbumine 3.B
+g9 3.B
+gA 3.
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optimal plasma separation
1. plasma?blood Do@ 1?/6. lo@ T0P
/. high blood Do@
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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
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E. ugularisinternaE.subclavia
E.cubitalis
E.femoralis
#essel Access
periferal vein
arterio"venous stula
central"venous access
!imino Fistula
$lood Access
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Anticoag!lation
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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
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S!bstit!tion
Iisovolemic, isotonic, isooncotic
Iallergen and p(rogen free, sterile
Icontaining coagulation factors andimmunoglobulins
Clinical%e&!irement
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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
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'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
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/!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%
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Albumine
&F 2olution
i.g. 6 'iters CL"2olution M C33 ml Albumine 63L H 1433 ml &F 2olution
Alb!mine Sol!tion
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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(
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Dil!tion *inetics
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+ntracellular 2pace M C3L
)*tracellular 2pace M 63L
+nterstitial 2pace M 14L
+ntravascular 2pace M CL
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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/
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Complications
tecnical medical
Access Problems &(potension
Plasma Filter !lotting Allerg(
lood 'eak Fever
&emol(sis &(pocalcemia
Arrh(thmia
)dema
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8ndications
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%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(
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Cascade Filtration
&eater
&eparin
V
V
PV
PA
BLD
SADPl
asmaFil te
r
PPL
SACCascadeF
ilter
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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