Apheresis

List the indications for Therapeutic Lymphocytapheresis

Indicated for use to reverse transplant rejection of any organ and autoimmune/alloimmune diseases such as RA, MS, SLE

List the indications for Therapeutic Leukapheresis

Indicated in AML and ALL before chemo with a WBC count greater than 100x10^3 mL

List the indications for Therapeutic Plateletpheresis

Indicated in patients with thrombocytosis/thrombocythemia (platelet count of 1 million or 1000x10^3 uL with goal to get them down to 600,000 or 600x10^3 uL)

Contrast the procedures of continuous flow centrifugation and intermittent flow centrifugation

Intermittent flow centrifugation -one venipuncture and can be mobile Continuous flow centrifugation -uses less extracorp volume which is important in children and elderly that have smaller blood volumes and take less time due to 2 venipunctures

What is the most common anticoagulant used in apheresis procedures and the what is its advantages and disadvantages

Acid citrate dextrose (ACD) -Disadvantage: causes citrate toxicity that decreases ionized calcium and causes tingles -Advantage: is it is quickly metabolize in the liver and prevent blood from clotting

Define apheresis

To separate or take away

List the components that can be collected using Erythrocytopheresis and the properties associated with them

-Also known as a red cell exchange -Treated for sickle cell patients -Requires 6-10 red cells

Compare the procedures of continuous flow centrifugation and intermittent flow centrifugation

-Both blood is drawn with aid of a pump and as blood leaves the individual an anticoagulant is added. -Sample is centrifuge and desired component is taken with remainder return to donor

What are the effects of HES during apheresis

-Enhances separation of red cells from WBCs -Has anti-coag activity that may affect coag cascade

What are the effects of Heparin during apheresis

-Filtration equip for granulocyte collection uses heparin, may put donor at risk of bleeding if there is an unknown problem -May cause thrombocytopenia and is associated with hypersensitivity reactions

State the regulatory requirements for apheresis donations, including frequency of donation

-Often called serial apheresis procedures -Have to monitor donors weight, blood count, serum protein levels, antibodies levels -Must have 48 hours between donations -Cannot remove more than 15% of donors total blood volume -If going for platelets, need to keep the red cell loss at less than 25 ml per week and plasma loss to less then or equal to 500ml per week

List the components that can be collected using Leukapheresis and the properties associated with them

-Removal of WBCs with return of RBCs, plasma, and platelets -Only good for 24 hours -Stored at room temperature -Used to treat neonatal sepsis -One unit should contain 1x10^10 granulocytes and 75% of units tested

List the components that can be collected using Plateletpheresis and the properties associated with them

-Removal of donor's platelets with return of RBCs, WBCs, and plasma -Stored at room temperature with continuous agitation -Used for patients with leukemia or aplastic anemia -Donors should not be taking medications that interfere with platelet function like aspirin for 3 days before donations -One unit should contain 3x10^11 platelets in 75% of units tested -pH should be greater than or equal to 6 -Last 5 days -In a 70 kg adult, platelets should increase 30,000 to 60,000/ul

List the components that can be collected using Neocytapheresis and the properties associated with them

-Removal of donor's reticulocytes and return of older RBCs, platelets, WBCs, and plasma -Reticulocytes are younger and will live longer -Used to treat patients with thalassemia major or patients that have continuous RBC transfusions -Risk is iron overload

List the components that can be collected using Therapeutic Apheresis and the properties associated with them

-Removal of plasma to treat underlying disorders -Can last several days to months -Do a 1.5 plasma volume exchange per procedure. -Primary treatment for TTP

List the components that can be collected using Plasmapheresis and the properties associated with them

-Removal of plasma with return of all cellular components to donor -Used to increase FFP, collected from patients with antibodies to herpes and varicella, collection of rare RBCs and WBC antibodies to manufacture anti-sera -Stored at -18 Celsius and good for 1 year from collection

Discuss the use of acceptable drugs and medications that can be used on donors to affect or increase the different pheresis products, including any side effects that the donor may experience

-Steroids -Heparin -Protamine -HES (hydroxyl ethyl starch)

Give disease that would be suitable for a complete plasma exchange

-TTP is the number 1 reason to provide patients ADAM-TS enzyme to cleave Von Willebrand factor -Good pasture syndrome for removal of basement membrane gammopathy -monoclonal gammopathy -protein bound toxins -get rid of lipoproteins -helpful for cutaneous t-cell lymphoma

What are the effects of steroids during apheresis

-Used to increase WBC prior to granulocyte collection -Large doses may induce headache, fatigue, joint aches, fluid retention, low grade fever

What are the effects of Protamine during apheresis

-Used to neutralize heparin at end of procedure -May cause anaphylaxis and hypotension

Describe the process of apheresis

-When centrifuged, anti-coagulated blood will separate into component layers on the basis of their different specific gravities -Then place a pipette at the correct level to remove appropriate component and then give back remaining to patient

State the sequence of separation for centrifuged whole blood

RBCs->WBCs->Platelets->Plasma