بسم الله الرحمن الرحيم. Introduction to Apheresis. SALWA HINDAWI MSc, MRCPath, CTM RCPE. Consultant Haematology & Transfusion Medicine Director of the blood Transfusion Services King AbdAlaziz University Hospital Phlebotomy Course, 11-13 April 2006. Early History.
MSc, MRCPath, CTM RCPE.
Consultant Haematology & Transfusion Medicine
Director of the blood Transfusion Services
King AbdAlaziz University Hospital
Phlebotomy Course, 11-13 April 2006
The word apheresis means, "to take away from"
Blood letting, Egyptian and Greek
Leeches, blood sucking worms.
The twentieth century separating blood components were recognized as a therapy called apheresis.
In the1950s discontinuous-flow manual procedure.
In the 1960s, continuous-flow hemapheresis machines introduced.
By the end of the twentieth century highly sophisticated machines has been developed.
In May 1981, one of the most important educational and scientific contributions to the apheresis practice, was establishing the American Society for Apheresis (ASFA)
Collection of a particular blood component from a Donor / patient and the remaining constituents are Returned to the donor or patient.
1. Centrifugation (specific gravity)
1. Component collections
Donors for apheresis procedure must meet the criteria applicable as the donors for normal donation.
CBC, ABO and Rh typing, andtibody screening and testing for transfusion and transmitted diseases(VDRL, anti-HIV I&II, HIV-1 RNA, anti-HCV, HCV-RNA, HBsAg, ANTI-HTLV I&II, RPR, anti-HBc and Anti-HBs if Anti-HBc positive) SHOULD BE DONE.
A drug history should be obtained; donors who have taken aspirin or aspirin containing medications within 3 days of donation should be temporarily deferred
The interval between platelet donations
should be at least 48 hours, with no more
than two donations in a week and 24 donations
in a year.
plasmapheresis donors may donate as often
as every 48 hours but not more than
twice in a 7-day period.
If it becomes impossible to return the donor's red cells during apheresis, at least 8 weeks shall elapse before subsequent apheresis procedure, unless the red cell loss was less than 200 ml.
The technical staff must be properly trained to care for donors and patients.
Attention must be given to the patients medication schedule and/or fluids replacement.
Written informed consent must be obtained from the donor & patient
Newborn 82-86 ml/kg
Premature 89-105 ml/kg
Infant 73-82 ml/kg
Extracorporeal volume (ECV) and TBV
ECV not more than 15% of TBV
standard medical care and accepted as primary therapy or first-line therapy in conjunction with other initial therapies.
Generally accepted, but usually as adjunctive therapy to other treatment modalities.
Published data is insufficient to establish efficacy or risk/benefit. Heroic effort treatment
Published control trials lack evidence of efficacy.
Leukemia with hyperleukocytosis
Sickle cell syndrome
Cutaneous T-cell lymphoma
(cytoreduction or photopheresis)
Hairy cell leukemia
Hyperparasitemia (e.g., malaria)
Peripheral blood stem cell collections for Hematopoitic reconstitution
Organ transplant rejection
Sickle cell disease
(prophylactic use in pregnancy)
Leukemia without hyperleukocytosis
Polymyositis / dermatomyositis
It is the removal and retention of the plasma with return of all cellular components to the patient.
Recommended 1-1.5 plasma volumes be exchanged
One volume exchange(2-4 L) unwanted plasma component to 30% of its initial value .
Thrombotic Thrombocytopenic Purpra (TTP).
Coagulation factor inhibitors
Rapidly progressive glomerulonephritis Chronic inflammatory demyelinating
Drug overdose and poisoning
Systemic vasculitis (primary or secondary to rheumatoid Arthritis or systemic lupus
ABO-incompatible organ or marrow transplantation
Maternal treatment of Maternal-fetal incompatibility (HDN)
Thyroid storm, Multiple sclerosis
Progressive systemic sclerosis
Pure RBC aplasia , Transfusion refractorines
due to Alloantibodies (RBC, platelet, HLA)
Warm autoimmune hemolytic anemia
AIDS (for symptoms of immunodeficiency)
Amyotrophic lateral sclerosis
Fulminant hepatic failure
ITP (chronic) , Lupus nephritis
Polymyositis / dermatomyositis
Psoriasis , Renal transplant rejection
1- Citrate toxicity
2- Vascular complications
hematoma, sepsis, phlebitis, neuropathy.
3- Vasovagal reaction.
5- Allergic reaction.
7- Air embolus.
8- Depletion of clotting factors.
9- Circulatory and respiratory distress.
10- transfusion transmitted diseases.
11- loss of lymphocytes.
12- depletion of proteins and immunoglobulin
Effects during Therapeutic Apheresis
The physician will determine if the procedure should be restarted or aborted.
SOB = shortness of breath; WB = whole blood; ACD = acid citrate dextrose;
FFP = fresh frozen plasma; ACE = angiotensin-converting enzyme.
Since 1996 adverse events (AE) in therapeutic apheresis (TA) More than 14,000 procedures were registered during the observation period .
No fatalities occurred
AEs were most frequent in patients with Good pasture's syndrome (12.5%), TTP/HUS (10.5%) and Guillain Barre syndrome(11.0).
Transf Apheresis Sci 2001, Aug;25(1):33-41
Donation & Therapeutic Apheresis is safe and easy effective methods to be used when needed.
A well-trained and experienced team can overcome the technical difficulties in order to complete the procedures without complications.
Policy and procedure of Donors Apheresis
And Therapeutic Apheresis should be in place.
Practices, 4th edition 1999.
5. Guidelines for the Blood Transfusion Services in the United Kingdom 4th Edition 2000.
6. AABB Annual Meeting, Oct 26-29 Orlando, FL USA 2002.
7. AABB annual Meeting, Nov SanDiago, USA 2003.
8. Apheresis Principles and Practice, 2nd Edition, Bruce C. McLeod
9. AABB Technical Manual 14th Edition, 2005.