APHERESIS METHODS AND TYPES APERESIS.ppt
- 1. 1 APHERESIS
- 2. Apheresis is derived from a greek word meaning “to take away” Technique in which whole blood is withdrawn – separated into its components – desired component is retained and remaining constituents are returned to donor DEFINITION
- 3. INDICATIONSOF HAEMAPHERESIS 3 To collect the components for transfusion purposes Platelets Leucocyte s - Plateletpheresis - Leucapheresis Plasma - Plasmapheresis Peripheral blood stem cells Toremove pathological component Therapeutic Apheresis
- 4. MECHANISAM OF ACTION Large-bore intravenous catheter is connected to spinning centrifuge bowl Whole blood collected from donor/ patient into the centrifuge bowl More dense elements like RBCs settle to the bottom – then WBC – Platelets – and plasma on the top
- 7. DonationCriteria 7 • Donors for apheresis procedure must meet the criteria applicable as the donors for normal donation. ABO and Rh typing, Testing for transfusion transmitted diseases Antibody screening • A drug history should be obtained; donors who have taken aspirin or aspirin containing medications within 3 days of donation should be temporarly deffered.
- 8. DonationInterval donor &patient 8 •The interval between platelet donations should be at least 72 hours, with no more than two donations in a week,4 times in a month and 25 donations in a year. •Platelet count should be more than 1.5 lakhs •Plasmapheresis donors may donate as often as every 48 hours but not more than twice in a 7-day period. •Serum protein concentration should be more than 6 gm/dl. •Written informed consent must be obtained from the
- 9. Methodology 9 Manual Method Apheresis Machines 1. Centrifugation (specific gravity) a) Intermittent flow IFC b) Continous flow CFC 2. Immunoadsorption Apheresis by membrane filteration
- 10. MANUALMETHOD Blood collected into plastic bag which containing anticoagulant preservative solution Bag centrifuged to get desired component, which is separated into a satellite bag Remainder is infused through the same vein. Process is repeated 1
- 11. DISADVANTAGES 1 The amount of components harvested is less than the automated machines. Time consuming. Volume of blood taken out from the body ismore.
- 12. APHERESISMACHINES 1 The machines are broadly of two types Intermittent flow centrifugation(IFC) Haemonetic Model S-30,V-50,MCS Dideco Progress Continous flow centrifugation(CFC) Cobe Spectra Dideco Viva Fresenuis
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- 14. Apheresis- Mechanism of Action 14 •Large-bore intravenous catheter connected to a spinning centrifuge bowl •Whole blood is drawn from donor/patient into the centrifuge bowl •The more dense elements, namely the red cells, settle to the bottom with less dense elements such as white cells and platelets overlying the red cell layer and finally, plasma at the very top.
- 15. INTERMITTENTFLOW CENTRIFUGATION Require the use of a disposable unit consist of sterile tubings and a bowl. Blood is drawn from an individual and mixed with the anticoagulant with the help of a pump and pumbed into centrifuge bowl through inlet port The blood gets separated in bowl into various components by differential centrifugation. 15
- 16. •The separated components flow from the bowl through outlet port, with the desired component being harvested into a separate collection bag. •The centrifuge stops and pump gets reversed •This completes one cycle. 16
- 17. Haemonetics centrifuge bowl. IFC Procedure. 17
- 18. ADVANTAGE Single venous access. 18 DISADV ANTAGE Time taken is more. Extracorporeal volume is more.
- 19. CONTINOUSFLOW CENTRIFUGATION Blood is withdrawn from an individual with the assistance of a pump, mixed with the anticoagulant Blood is collected in a chamber/belt Separation of the components is achieved through centrifugation Desired component is diverted into a collection bag and remainder is reinfused into individual through second venous access. 19
- 20. ADVANTAGES 20 Time required is less Less extracorporeal volume DISADV ANTAGES Two access required.
- 21. PLATELETPHERESIS 21 Removal of platelet from donor and return of red cell, white cell and plasma The platelet concentrate prepared by cell seperator should have minimum2.5x1011 Routine procedure takes 90 min-2 hours Stored for 5 days on platelet agitator at 22 degrees.If it is prepared in open system, It must be transfused with in 24hr. INDICATIONS Thrombocytopenia Aplastic Anemia Bone marrow Transplant.
- 22. LEUCAPHERESIS 22 Removal of leucocytes with return of red cells, platelets and plasma. Required for treating sepsis. Granulocyte concentrate must contain minimum of 1x1010 granulocytes . Shelf life is 24 hours. Granulocyte collection yield by apheresis procedure can be increased by ◦ Giving steroids ◦ Addition of red cell aggregating agents Eg.HES
- 23. CORTICOSTEROIDS Corticosteroids are believed to increase the vascular pool of granulocyte by stimulation of bone marrow to increase cellular output to blood. eg., Dexamethasone- Dose-6-12mg, prednisolone-40-60mg Haematopoietic growth factor G-CSF OR GM-CSF Hydroxyethylstarch It is available as6% solution in0.9%saline and is added to the input line of cell seperatorin the dose of 170- 500ml for 4-10 litter of blood. 23
- 24. NEOCYTAPHERESIS 24 PRINCIPLE OF SEPARATION Young, larger and less dense red cells are expressed earlier than older cells. In patients requiring repeated transfusions The administration of relative young cells will improve management by Decreasing frequency of transfusion Decrease the rate of iron loading. Expensive, time consuming.
- 25. PLASMAPHERESIS/PLASMAEXCHANGE 25 It is the procedure in which the whole blood is withdrawn from donor/patient, anticoagulated and separated into components with return of separated cellular components to donor/patient If relatively small volume of plasma are removed and replaced by saline, the term Plasmapheresis is used. If more plasma is moved, it become necessary to infuse plasma or plasma protein fraction to replace the lost plasma proteins, this is called Plasma Exchange
- 26. INDICATIONSFOR PLASMAPHERESIS 26 Removal of antibodies ◦ Allo antibodies HDN Anti Rh antibodies in pregnant women Neonatal thrombocytopenia ◦ Auto antibodies ◦ Myasthenia gravis Acute polyneuritis Removal of immune complexes o SLE o RA
- 27. Hyper viscosity syndrome Multiple Myeloma Waldenstorm’s Macroglobulinemia Removal of toxins Hepatic failure Renal failure Replacement of deficient plasma component TTP HUS 27
- 28. APPLICATIONOF PLASMAPHERESIS 28 Plasmapheresis of normal donors for preparation of plasma fraction Therapeutic plasmapheresis- to remove some particular constituent from patients plasma REPLACEMENT FLUIDS FOR PLASMA EXCHANGE Crystalloid Albumin Plasma protein fraction (PPF) FFP
- 30. COMPLICATIONSOFPLASMAEXCHANGE 30 Reactions to replacement fluids Vaso- Vagal reactions Pyrogenic reactions Hypothermia Hypocalcemia Thrombocytopenia Anaemia Hypogammaglobulinemia
- 31. THERAPEUTICLEUKAPHERESIS 31 Has been tried in patients of CML, but general opinion is that apheresis is ineffective probably due to rapid production rate of cells in comparison to the number of cells removed through apheresis. Leukapheresis is most effective in Chronic lymphosarcoma Prolymphocytic leukemia Hairy cell leukemia Eosinophilic syndrome Sezary cell syndrome
- 32. THERAPEUTIC THROMBOPHERESIS Done in cases with essential thrombocythemia RED CELL PHERESIS Done in patients with sickle cell disease especially during sickle cell crisis Severe parasitic load 32 ADV ANT AGESOF APHERESIS Less HLAsensitization. Less chances of TTD. More effective than usual component donation
- 33. PHOTOAPHERESIS It is a form of apheresis in which blood is treated with Photoactivable drugs which are then acttivated with UV light. • It is approved for cutaneous T cell lymphoma(CTCL) •It is also affect in T –cell mediated disorder eg:GVHD Solid organ transplant rejection PROCEDURE • Perfomed through intravenous acees •The process takes 3-4 hr to compleat the process • 3 Basic stage 1.leukapheresis 2.Photoactivation 3.Reinfusion
- 34. • Peripheral intravenous line or central venous access is established in patients • Blood is passed through the different cycle of leukapheresis depend on the patient hematocrite value and body size and at the end of the each leukapheresis platelet and plasma is returned to the patient • The collected WBCs( Peripheral blood mononuclear cells) are mixed with heparin, saline, and 8- methoxypsoralen(8-MOP),Which interacts into the DNA of the lymphocytes up on exposure to uv light and more susceptible to apoptosois. • The treated WBC mixture is returned to the patient.
- 35. ADVERSE EFFECT OF APHERESIS IN DONORS 35 Citrate toxicity Donor may feel numbness or tingling sensation around the mouth. Problem solved by •Giving exogenous calcium •Decreasing the rate of infusion of returned component Adverse effect of HES may occur Febrile allergic rections: Head ache, Mild hypertension Edema of extrimities
- 36. COMPLICATIONS 36 Hypocalcemia Air embolism Hypo fibrinogenemia Hypotension Vaso vagal reactions Haematoma, infection in the site of venous access Allergic reactions
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