Scribd
Upload
154 views15 pages

Therapeutic Plasma Exchange - Presentation 1

Please

Uploaded by

hameedmarbrajhe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPSX, PDF, TXT or read online on Scribd
154 views15 pages

Therapeutic Plasma Exchange - Presentation 1

Please

Uploaded by

hameedmarbrajhe
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPSX, PDF, TXT or read online on Scribd
You are on page 1/ 15

Therapeutic Plasma Exchange

PM-0100-05/2016-1
Copyright © 2017 NIKKISO Co., LTD. All rights reserved. |
Confidential
Indications for Therapeutic Plasma Exchange
(American Society for Apheresis) 1
• Acute Guillain–Barré syndrome
• Chronic inflammatory demyelinating
polyneuropathy
• Myasthenia gravis
Neurological
• Polyneuropathy associated with
paraproteinaemias
• Paediatric autoimmune neuropsychiatric disorders
associated with streptococcal infection
• Thrombotic thrombocytopenic purpura
• Atypical haemolytic uraemic syndrome
Haematological (autoantibody to factor H)
• Hyperviscosity syndromes (paraproteinaemias)
• Severe/symptomatic cryoglobulinaemia

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 2


l
Indications for Therapeutic Plasma Exchange
(American Society for Apheresis)1
• Goodpasture’s syndrome (anti-glomerular
basement membrane antibodies)
• Antineutrophil cytoplasmic antibody (ANCA)-
associated rapidly progressive
Renal glomerulonephritis
• Recurrent focal segmental glomerular
sclerosis
• Antibody-mediated renal transplant rejection

• Familial hypercholesterolaemia
Metabolic (homozygous)
• Fulminant Wilson’s disease

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 3


l
Therapeutic Plasma Exchange
Therapeutic Plasma Exchange (TPE) has been
increasingly used over the past decade as a first-line
and lifesaving treatment for various conditions
classified by the American Society for Apheresis
(ASFA).

To date, the degree to which utilization of TPE in


paediatrics mirrors recommendations is unknown2.

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 4


l
Plasmapheresis and Therapeutic
Plasma Exchange
In common usage, the terms
therapeutic plasma exchange and
plasmapheresis are used
interchangeably.

The two procedures are clinically


different…

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 5


l
Therapeutic Plasma Exchange
This procedure is where a large volume of plasma is
removed from a patient.

The volume removed is such that if it were not replaced,


significant hypovolemia resulting in vasomotor collapse
would occur.

As a result, the removed plasma must be replaced with


some form of replacement fluid.

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 6


l
Plasmapheresis

Plasmapheresis removes a smaller amount of plasma,


typically less than 15% of the patient's blood volume.

Many treatments involve a process of cleaning of the


patients’ own plasma and it’s return.

This therapy does not always require replacement of the


removed plasma.

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 7


l
Plasma Filters
 Whilst plasma components such as albumin, electrolytes and
enzymes are able to pass through the pores in the fibre wall,
the pore size is designed to prevent the red cells being
filtered.

 Pore widths:

o HF filters = 30 microns
o TPE filter = 50 microns

 MPS filter fibre cut-off is 980 000 Daltons

o Albumin 69 000 Daltons


o Immunoglobulin A 150 000 Daltons
o Immunoglobulin G 180 000 Daltons
o Immunoglobulin M 900 000 Daltons
Copyright © 2017 NIKKISO Co., LTD. All rights reserved.
Common Replacement Fluids for
Therapeutic Plasma Exchange3

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 9


l
Fresh Frozen Plasma (FFP)
 Fresh Frozen Plasma refers to the fluid
portion of donor blood, separated and frozen
at −18 °C (0 °F) within eight hours of
collection4.
 Pros:
o Iso-oncotic
o Replaces clotting factors, immunogloblins and other
plasma proteins
 Cons:
o High risk of reaction or infection
o Provides citrate which may result in hypocalcemia
o Needs to be blood type compatible
o Expensive
Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 10
l
Albumin 5%
 Albumin (Human) 5% is a sterile, liquid preparation of
albumin derived from large pools of human plasma,
typically provided by approved blood transfusion
services5.

 Pros:
o Colloid which is iso-oncotic so therefore will remain in
intravascular space
o Very low infection and allergenic risk

 Cons:
o Doesn’t replace clotting factors
o There have been periodic shortages
Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 11
l
Access is still KING:

Adequate venous access, with good flow and return, is


required for Therapeutic Plasma Exchange (TPE). Both
central or peripheral vascular access can be used.

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 12


l
Peripheral Access6
A wide bore peripheral catheter is inserted in either the
antecubital or femoral vein.
PROS:
o Less invasive
o Faster to place
o Less risk of line sepsis
CONS:
o Patient must have good veins with reasonable
muscle tone to maintain blood flow
o Lines sit in positional spots so the patient must be
able to cooperate in remaining still for the procedure

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 13


l
Central Access7

Double lumen central access normally placed in the SVC


via femoral, subclavian and internal jugular vein access.
PROS:
o Able to cope with high flow rates and patient
movement
o Staggered ports which minimize recirculation
CONS:
o Invasive procedure for insertion
o High risk of line related sepsis
o Complications associated with insertion such as
pneumothorax, arterial puncture and bleeding

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. | Confidentia 14


l
AQUARIUS system ACCUSOL solution AQUAMAX hemofilter AQUASET CITRASETRCA
NIKKISO Europe GmbH Nikkiso Belgium Nikkiso Belgium bvba Assembled by Haemotronic Assembled by Haemotronic
Desbrocksriede 1 bvba Industriepark 6 Via Carreri, 16 Via Carreri, 16
30855 Langenhagen Industriepark 6 3300 Tienen 41037 Mirandola 41037 Mirandola
Germany 3300 Tienen Belgium Italy Italy
Belgium

Aquarius, Accusol, Aquamax and Aquaset are trademarks of Nikkiso


Co., Ltd.

Copyright © 2017 NIKKISO Co., LTD. All rights reserved. 15

You might also like