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Plasmapheresis

Plasmapheresis. Jeff Kaufhold MD FACP April 2009. Plasmapheresis Summary. Indications Renal Non Renal How it works Orders. Plasmapheresis. Renal Indications: Lupus Anti-GBM RPGN HUS/TTP Wegener’s Rejection/Prior to transplant in high PRA pt Cryoglobulinemia. Plasmapheresis.

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Plasmapheresis

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  1. Plasmapheresis Jeff Kaufhold MD FACP April 2009

  2. Plasmapheresis Summary • Indications • Renal • Non Renal • How it works • Orders

  3. Plasmapheresis • Renal Indications: • Lupus • Anti-GBM • RPGN • HUS/TTP • Wegener’s • Rejection/Prior to transplant in high PRA pt • Cryoglobulinemia

  4. Plasmapheresis • NON-renal indications • Hypertriglyceridemia • Myasthenia Gravis • AIDP (guillian-Barre’ syndrome) • Myeloma • Waldenstrom’s Macroglobulinemia

  5. Plasmapheresis Functions • Removes Immune Complexes • Removes Antibodies • Removes Plasma (for high lipids) • Removes/activates Complement • Removes inflammatory mediators • Infuses FFP or IVIG which results in anti-idiotypic antibodies (blocking antibodies which attach to Fc portion of antibody) • Can be thought of as another immunosuppressant.

  6. Dialysis and Plasmapheresis • Similar immunosuppressant functions: • Reduce inflammatory mediators • Reduce complement by activation • Reduces fibrin • Acts as an immunosuppressant • Lupus becomes quiescent within 6 months of starting hemodialysis. • Anti-GBM antibodies clear.

  7. Dialysis and Plasmapheresis • Similar immunosuppressant functions: • Exposes blood to plastic tubing, resulting in complement and fibrin activation and deposition • Biocompatible membranes cause less complement activation • Bio-incompatible membranes resulted in Dialysis Amyloidosis, also known as Beta-2 microglobulinemia deposition disease.

  8. Plasmapheresis Orders • Frequency: • Daily or MWF depending on severity of disease • Blood pump Speed: 50-150 cc/min • Liters processed: 25-30 vs 70 with HD • Supplement with: • FFP 15-20 units/treatment • Albumin 3 liters/treatment • Anticoagulation: • Citrate vs heparin depending on platelet count

  9. Schizocytes

  10. Whole blood fractions

  11. Plasmapheresis Centrifuge

  12. Plasmapheresis Patient

  13. Hepatassist for liver failure • Plasmapheresis • Circuit for • Regeneration of • Perfusate and • Oxygenation • Hollow fiber kidney • Porcine Hepatocytes

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