Apheresis [ done ]

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photopheresis

Utilizes leukapheresis to collect the buffy coat layer from WB used for the treatment of cutaneous T cell lymphoma - treated with 8- methoxypsoralen (8-MOP) - exposed to ultraviolet A (UVA) light then re-infused

why are hematopoietic stem cells commonly used prior to HPC collection?

increase # of circulating stem cells in PB

what is therapeutic plasma exchange?

removal and retention of the plasma, with return of all cellular components - removal of an offending agent in the plasma - replacing a normal factor or substance that may be missing/deficient in the patient's plasma effective tool to remove IgM antibodies

HPC apheresis definition

removal of HPCs - also referred to as PBSC (PB stem cells)

erythrocytapheresis definition

removal of RBCs

plasmapheresis def

removal of plasma

plateletpheresis definition

removal of platelets

leukapheresis definition

removal of white blood cells (WBCs) - in donors, granulocytes are collected - in patient, removal of granulocytes and lymphs

what is the therapeutic goal of RBC exchange (erythrocytapheresis)?

remove incompatible RBCs from patient's circulation

Erythrocytapheresis

removes a large number of RBCs from the patient and return the patient's plasma and platelets with compatible allogeneic donor RBCs - most commonly used to reduce complications of sickle cell disease (reduce hgb S to less than 30%)

separation of blood components is based on ?

specific gravity or weight of each constituent

leukapheresis is used for ?

treat patients with hyperleukocytosis

RBC donation

typically collected as a double unit - 2RBC, double red, or double RBC procedure - reduces donor exposure for recipient - both autologous and allogeneic - saline infused during to account or blood loss

what are the two common methods of centrifugation and compare

Intermittent Flow Centrifugation (IFC) - processed in batches (or cycles) - single- needle procedure with one venipuncture site - instrument: Haemonetics MCS plus Continuous flow centrifugation (CFC) - blood withdrawal, processing, and reinfusion performed simultaneously - two venipuncture sites - instruments: COBE spectra, Baxter/Fenwal Amicus

frequency of plasma (infrequent) donation

every 4 weeks, no more than 13 times/year

frequency of platelets, double or triple

every 7 days

The most common fluid replacement for TPE is __________________

5% human albumin

one WB platelet should increase the adult patient's platelet count to

5,000-10,000

platelets are leukoreduced; so they must contain less than __________ WBCs per unit

5.0 x 10^6 /µL

each unit of platelets from WB (RDPs) must contain at least _____ platelets

5.5 x 10^10

the concentration of most plasma substances is reduced by _________ after one standard plasmapheresis treatment

50-60%

If one RBC and one plasma/platelet product are collection, how long must the donor wait to donate another RBC product?

56 days

apheresis platelets provide the equivalent of __________ units of WB-derived donor platelets

6-8

the patients extracorporeal blood volume (ECV) should be ______% of the total blood volume (TBV) in order to minimize risk of hypovolemia

<15%

leukapheresis is defined as a WBC or blast count of

>100,000

What is the rationale for therapeutic apheresis (TA)?

A pathogenic substance exists in the blood that contributes to a disease process or its symptoms. Said substance can be more effectively removed by apheresis than by the body's own mechanisms

Apheresis definition

A procedure where whole blood is removed from the body and passed through an instrument that separates out one or more blood components. The remaining portion is returned to the individual - patient or blood donor

membrane filtration technology

Alternative method for plasma collection only - membrane separators are typically composed of bundles of hollow fibers or flat plate membranes with specific pore sizes - pores can be sized to prevent the passage of even small cellular elements Advantages - cell-free product - ability to selectively remove specific plasma proteins

what type of centrifugation requires two venipuncture sites?

Continuous flow (CFC)

what are the side effects of the RBC sedimenting agent, hydroxyethyl starch (HES)?

Headaches, peripheral adema

frequency of granulocyte donation

every 2 days

frequency of plasma (frequent) donation

every 2 days (no more than 2 times in 7 days)

what three effects may be impactful on the donor's body when donating for apheresis?

- anticoagulation - fluid shifts - cellular loss

variables for consideration

- centrifuge speed and diameter - dwell time of the blood in centrifuge - type of solutions added - cellular content or plasma volume of the patient/donor - leukoreduction occurs during apheresis process

what are most deaths from during therapeutic apheresis?

- circulatory overload (cardiac arrest or arrhythmia)

adverse effects of apheresis

- citrate toxicity - vascular access difficulties (catheter insertion) - vasovagal reactions (fainting) - hypovolemia - allergic reactions - hemolysis

what is the criteria for a granulocyte donation?

- infection for 24-48 hours that is unresponsive to treatment - myeloid hypoplasia of bone marrow - chance for bone marrow recovery

what are the clinical considerations for TPE (therapeutic plasma exchange)?

- overproduction of specific monoclonal antibodies or polyclonal antibodies

combined IFC and CFC

- single platform - draw/reinfusion (IFC) - centrifuge (CFC) - allowed for concurrent collection of blood components and leukkoreduction - instrument: Caridian BCT Trima, Baxter/Fenwal Alyx

what patient population benefits from granulocyte donations?

1. Neutropenic neonates with sepsis 2. Patients who underwent aggressive chemo (neutropenic)

what are the 4 indication categories for TA?

1. apheresis is standard and acceptable in primary therapy (first-line) or with other therapies 2. generally accepted in a support role or second-line treatment 3. decision making should be individualized 4. clinical applications should be based on approved research protocol

granulocyte apheresis must have a minimum therapeutic dose of _______ per day

1.0 x 10^10

Per AABB standards, the extracorporeal blood volume should not exceed ______ mL/kg of body weight

10.5 mL

what is the maximum L for plasmapheresis?

12L or 14.4L for donors over 175lbs

frequency of double RBC donation

16 weeks (112 days)

Each apheresis of plasma is the volume equivalent of at least ______ whole blood derived plasma units

2

one plateletpheresis should increase the adult patient's platelet count to

20,000-60,000

Platelet donors have an acute fall of _________ for cellular loss

20-29% - greater in female donors - considerations: mobilization of platelets from the spleen

a pool of 4-6 RDP units will contain roughly _______ platelets

3 x 10^11

plateletpheresis component is prepared from one donor and must contain a minimum of ______ platelets

3 x 10^11

What is the HCT requirement for double RBC donation (RBC apheresis)?

40% - quantitative method used to determine hgb and hct levels (no copper sulfate method)

how long is an aspirin deferral for plateletpheresis?

48 hours

frequency of donation for single platelets

every 2 days (not more than 2 times in 7 days, no more than 24 times per 12- month period)

Effects of anticoagulants

acid citrate dextrose is the primarily used anticoag - binds to calcium ions to inhibit Ca-dependent coag cascade - metabolized by liver, kidney, and muscles - previously bound calcium ions are released back into blood stream donor management - chills (provide blanket) - possibly give oral calcium tablet

vascular access

adequate vascular access is mandatory - peripheral veins, central veins, or a combination of both the patient must have adequate veins at TWO sites capable of accommodating a 16-18 gauge needle

Effects of fluid shifts

changes in intravascular volume occurs secondary to removal of blood - without infusing donor with additional fluid, donor may experience hypotension and an increased heart rate - hypovolemic reactions involve the sympathetic nervous system (not commonly encountered due to extracorporeal restriction of 10.5 mL/kg) - vasovagal reactions involve the parasympathetic nervous system (decreased heart rate)

who is most at risk for hypovolemic (volume depletion) considerations?

children and elderly individuals

Cytapheresis procedures vs plasmapheresis procedures

cytapheresis - selectively removes RBCs, WBCs, and/or PLTs plasmapheresis - removes plasma when a pathological substance is found in circulation

granulocyte donors see a drop in HCT of _____ and PLTs by ____%

drop in HCT of 3% drop in PLT of 22%

methodology of apheresis

modern apheresis instruments utilize a computerized control panel, allowing the operator to select the desired component to be collected or removed onboard optical sensors - detect specific plasma-cell or cell-cell interferences - divert component to specific bag disposable equipment - sterile single tubing sets, bags, and collection chambers duration - 45-120 minutes - HPCs can take longer Goals - determine instrument selection (donor or therapeutic apheresis)

leukapheresis - patient population - reduces WBC by how much?

most commonly in patients with AML and ALL - reduces WBC by 30-60%

immunoadsorption

refers to a method in which a specific ligand is bound to an insoluble matrix in a column or filter - selective removal of the pathogenic substance - reinfusion of patient's own plasma and cellular components

charcoal

used in selective adsorption - removal of bile acids

polymyxin B

used in selective adsorption - removal of endotoxin

cellulose acetate

used in selective adsorption - removal of granulocytes

staphylococcal protein A

used in selective adsorption- cell wall component of S. aureus - affinity for IgG classes 1, 2, and 4 and for IgG immune complexes

Therapeutic plateletpheresis

used to treat thrombocythemia with related symptoms - risk of thrombotic or hemorrhagic complications (platelet count exceeds 1,000,000/µL) reduces platelet count by 30-60%

what is the PLT count minimum for plateletpheresis?

≥150,000/µL


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