Plasmapheresis
 Principles, Methods & clinical use
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1. Pineda AA. Applications of Therapeutic Apheresis. Myoclinic proc. 1994, 69:
893.
2. Winters JL, Pineda AA. Hemap...
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1. Hodgson WJB, Mercan S. Hemapheresis listening post: optimal venous access.
Transfus Sci. 1991, 12: 274.
2. Winter...
overview. Ther Apheresis Dial. 2003, 7: 382-90.
12. Bosch T, Wendler T. State of the art of Low-density lipoprotein Aphere...
ASAIO Trans 1990; 36:M597.
23. Jones HG, Bandarenko N. Management of therapeutic apheresis patient. In
Mcleod BC, Price TH...
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10. Owens MR, Sweeney JD, Tahhan RH, et al. Influence of type of exchange fluid
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Transcript of "Plasmapheresis"

  1. 1. Plasmapheresis Principles, Methods & clinical use
  2. 2. "$ # """ ! "4567 3 0 1 ,2 & , ,-* ./ + )* % & '(% "1 : 3 ;469 + 8 & '(% 978 ?964 ? 2740 ?18?5 <= > D @ 2 ) A BC E = 2/ A> F C 3 . E > 0 1 ,2 . E > "RM 475 G6 4567 # / = I4J 5H = 4LI54HH K E (= 2/ > ! ! 2 C K 2/ ? 2/ ? M # ): 2/ = K / 2 2/ ? . . P ) 2/ ? N)D E O 2/ M # ): 2/ R + & Q = 0 1 ,2 & , ,-* ./ R + = 3 + & %2 > 67 . 31 G S A= E(@ 6JT ! > + * %2 # + E@ V -U G S 3 ! 2 H76 ?HI9 ?L79T?47 ?6 <= > * LJTT A W [ = : A + )> ! .= X PY Z > ! .= ? )* % www.ibto. ir 0 1 ,2
  3. 3. ! ! <>. M # ): 2/ 0 1 ,2 K % <>. 2/ ? 2 0 1 ,2 + #% ] K 2/ 2 C K 2/ ? 2 0 1 ,2 ^ _'(* ` N)D E O 2/ R>. ] K #% K &a + Y ^ * _'(2 .. P ) 2/ ? 2 0 1 ,2 <>. = K / 2 2/ ? 2 0 1 ,2 M # ): 2/ R + & Q =
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  6. 6. N O# - 9 "-P ( > : - &Q B I K 5D R F) < B C E 1 G TPE JK ' A TPE I F' F) N :S TIF !( < F U* ! > ,7 - ! , J" TPE JV ='%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% BC 9 CTPE 1>< ? @ A ! 6 &9 !G < F IWC D =5%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% TPE : ! I P"9 !$ X 9C ' 7 YZ 9C ' 7 Y Z 37 < > P"9 $ % [)?> $ ^ ]<> )9, # ] $ 6 ") $G B3 9 ? > $G FFP_ ) <>< B -4 $G 3) )8'()='%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% TPE9 7 B F"6< DE 0 )8L%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%G"H < @I/JK ($ 1 -= 3 < ,: & ) & : S -= 3 < ,: & ) & 6 Q " G % IMW " " A Z C ; M5] < > " N <S9 M5] * 1< ,: & < B- =
  7. 7. ! 4 &9 ) Q `V ) $ <S9 M5] E [ U < > < - 7 - Z C ; a IWC D ( 99 < = ] - _M) 4 b "B D M5] IWC D = *9 )&'%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%1< M 1< K @I/JK Z" M )Z) M ) " Z Z 3 B> ! 4 &9 < > :; ) $ , c[ ? > " ( ) 3Q 9 ( & &9 % D 4 d^ F < F 9 ' < > * ""9 = G D < > 4 & &] - < - 7 N Z" M )% B % B ) Z 3 B> D E9 ! RBC e3 D <,C 7 Z C 7 B 7 )4)%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%G"H < " @I/JK G B" 3 - &Q 9 G f Q " GA * P gF <= 3 &Q GN &5 E[ ) G ZB[ O3c G! ) < R] G$ Reject A( < B- ] )*)%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%GBN3 GB C J @I/JK A B3 [&9 ? > A [' < B - AA O B[ > 1 , P - ,h A M9 1 L
  8. 8. ! " # $" % & ' " ( " # $" ( )& ( *+ " , - - *+ . / " + ) + 0 1+ 9 :& $ . +$ ;< " # + =, 2 /+ 3 ( $ . 2( - 4+$,# 3 5 ,( 6 7. "8 *# @> 3 ? %- ( > /& $- A3B5! 30 $ 0", >30 ( 6 ,C ! 3<- E 6 * + %F -. ( - 4+$,# 3 5 . 0 A) A -$ D D+ # >/) =5& 6 " , 4+$, # 3 5 =" ( 6 26 30 . ,( G),- '+ A! ( & - A3 $ @ ( H- AA6 - H 3( - =" *+ $ 6 I JK( + <& 0 4+$,# 3 5 M: - I JK( ! A+ # " 9L :& ( ) & ( " - @; ( ,N *+ <- O P " ,Q !" #! $ %!
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` 3 /% 0( / '
  11. 11. %$#" ! aphairesis - , ! . * /- 01 * ' ( ) *+ , ! &' % ! ! &23 ! 51 &' 4 # 7 01 * 8 9 4 :;< ! * 9 - 6 + * 01 * 2 –# @ - 3 '8 A9, 7 2 6 % 2, * ! =9 > + ? E B %1 G 2 A F 9 29D ' CD 2 1 ! & CD ) F I1 J ! F & CD + * 01 * H & CD – @ K L2 D M9 > N O ! & CD ( L F D 2P ( L F D . * - !> 2, G R & CD Q F I1 J ! ! ! ' & CD &23 ! , ! ! 1 &2! ! 1-F ! *U1 2SF 1 T ! & CD - &F ! > 2P ! K L F D ) ? < & CD 01 * W ' ! * 8 X Y Z D V2 ? + -Y I 6 !7 F8 & CD ; &R< ! 1 [R< A % G R +2 A $ 2 ; 2 9 " & CD A; Hendon ! F 1 1 ^1( ? ! &' 1 1 2X]F + F ! ! RF R 1-F ; 7 * + * 01 * ! I 2< 1 1 )&? + 7#_`@ 8 1 + 2! 2 + 1 %$@" ! 1 6! ; 1 1 1 ! 1 ^ 1 + #_`_ 8 1 Fleig % 1 1 & CD 01 * ^ 1 #_#E 8 1 ) 3 a 1 6&' Abel ! 1 2&' 2! X :; ! b2c F 7 ! ! S 29 SY 2 &; 1 7S *+ 11 ' ! 2, 9 ?1 ! -2 & ': D FG 1 T !G %$B" & 2!a2D 1 F4 2! = 1 GR 1 & CD 1 - Cytapheresis 2- Leukopheresis 3 - Erythrocytapheresis 4 - Plateletpheresis 5 - Plasmapheresis
  12. 12. '+2dF D R 2 F ? I1 3 a & ! R ; 1 2 & CD 2SF 7 2 ^1 h, , g* ! f A; 1 ? ! :9O e 1 2AO &< D 2, 3 2 '^ 1 + +62 7 * iD 6 1 1 * ' 1 = +2 j&' ! R 1-F L = 8A ! * 0 * 2 h7 ! R 1 :F S ! , 9& FC6 7 S 1 + 1 2Y * ' 2 % ! L= 62 CD * ' ;2 a 2D ! -&' 7#_H` ' ) #_E` ' * 1 8 1 %$B" F ;, = 7 1 ^ 1 ( ? ! &' 7 F 2D 1 8 j> % = & CD ^ 1 * ' 1 2SF ! Carifols – Lucas 7#_H@ & CD L = = ! - 3 8 A9, K 7 , ' ) * :2F F + ! = +2 j&' % ,! ' ! 2Y * D =' ( - 3 '8 A9, ^1 ! G R % ^1 -, 1 Z ! * 1 ! C A 1 &2! h 1 1 1 1 +2 j&' % ! 1 2;! O ! I 2 F * ' 1 '[R< 2SF ! 1-F ' ! Y - 3 8 A9, 7 kF 1 g! +6& ^1 % 1 * ' Y * ! X ) ; + % l ! R < Cohn L = G # )6 )A3 8 e` a2! G !L = = Edwin Cohn #_H` ' 1 * ' 1 2SF ! 1 ! 4 * A n J1 W k ! De Laval m F 7 ! ) AF 1 ^1( ! G S p O 1 & CD >! o AS! 1 ;! [ ;2 ( 1 * - On – Line 6 ' Y + %$@" 1 i, D 8 A Latham G 4 ! ! + % ! ) 7 ! IZ k] R2 1 [' +2? 1 2 >! AS! 1 1 n& ! Cohn ! L = G <O % 1 < O+ ' A q !8<
  13. 13. +2! 1 RF S2 +2 S 6 7 George Judson 7#_e@ 8 1 r 1 Emil.J.Freireich ! $ NCI " ; 99& +2! 2 ; 1 $eIBM" 99& %$H" ! + - 2 92 & ! C A f 2* ! ^ ;D 1 ! (& ! '1 R ; s 2 Y ( !$ NIH" S! 9 2 ; 1 Judson 3 ! + GR ! 1 3 2 < O 6 6 + ! GF * ' 2 6 ! 'Y 2SF ! NCI IBM &< ! Judson t$B" 1 62 CD ' ? &R ) Y + % IBM @__` Y 2 F ! * D +2 ! 1 G ! ;! [ ;2 ( ! ) fCA3 W k 1 A6 $E"Latham G u@ )6 Y + % 1 [' 1 * [R< ^ D 6 69&? +2 h ! ! 'Y % ! - 3 '8 A9, 2 = 7 2 , 7 CD 1 n& 7 & CD Q F G R ! 1 3 D & -2&F G- * 2 1 L= G 9? ! = 1 3 = 1 ! ' Y 2 F ! D ? ! 7 ] 7 = 1! ' %$H" , $E" NCI/IBM @__` Y uB )6 6 - International Business Machines 7 - National Cancer Institute 8 - National Institutes of Health
  14. 14. M ! '1 ,1-! ! G +2&' ! 2 * ! Aminco * ] ! 1 * Aminco 1 F 2 ) * L= % ! &? 1 7 ! 9* 1 ! k ? + F( - 7 & CD 2; T * k ? + F(A Z ! J ? + F( - 7 ;' 1 1 2; + F(A 9 J ? +2! 1 ' CD 62 < * k ? + F+2Y " - 3 '8 A9, &' * ' 2 , ' 2 = K % ! & CD % 7 1 * Z )! X n3 1 , 1 3 $ 2; T 1 n& 7 v 1 3 J * * ' Z1 29>F '8 m F 7 * J ? 4 ' ! !G O ! * ' &;3 w=< 2 1 k ? % % ! C F R = )! 3 7Aminco % ,! ! 8J T Y + %$B" , 1 3 x 1 #_rr 8 1 IBM @__r Y 2A W k 1 A6 62 CD 8 ( !L= G 1 ! Aminco Y 7L = G ! ; X 1 ! ! & R< ( 78 + % ! + -Y I ! % F 7 )J < 9 F[2>c ' Z R2 1 a' 1 , 9* bg 1 y g* 8 +2! * h ':;h ! ' Y + [S [' 1 [ ;2 ! ' 1 * 6 1 ! * I1 J1 ':;h + % ! 0 * 7 * Cobe K& ! IBM a>! % ! [' &23 , 8 < +2? 1 * ! R 7 ':;h )q n 1 S ! '^CF % & 2SF 1 @__r L 6F L 6F G F , :;h ! L= +2 ? ! #_r_ 8 1 CS B``` %$H" 2 R #_ss 8 1 Cobe Spectra Y ! :;h !L = $E" IBM2997 Y uE )6
  15. 15. x 1 F1 RF I1 k! #_s` ' ) 1 7 2 F Fenwall 92 ! CS3000 z )6 ! * h T=] ) G ! Y ( 7 92 + % ,1 3 %$e" ! F K % X c <) * CD P & CD 7 T=] ( 1 )6 ! T=] ( 1 ! G-2 6 = ! 7' 2 , % & 1 n& 1 ' CD , I1 k! 7 ' 2 , CD ^ 1 = ! F 1 & CD % 7I = % & 1 n& & SPECTRA ? ]F 92 ( ^ !4 Cobe K& #_ss 8 1 ! -SR (2F F 4 + 1 1 Cobe/IBM @__r I 2J k* 1 2;! Y + + ! C? % & 2 F 7 2= 8 A9, , )3 < ! 1 CD IZ k] F 2K ' % ! 1 &2! N F ! 8 X )! 3 1 '^ 1 G R ! ! { ] Spectra 1 2 G ! '+2 Cobe Spectra , Fenwall CS - B``` Yv 7 g2] * > - $Stem Cells" 2 ! '8 9 1 n& ! ;' 1 %$e" 2, 1 3 = 1 2SF Latham x !| ! 9 ( Haemonetics K& O* !% ,1 3 M ! A; < ! '1 1 7 + % & 01 * M & ! RBC 7 1 F 2 ) * Y'7 )6 Y 01 * ! F(A 9 J ? & CD )' RBC [ }? ! 1 7I = ' ;2 1 :2F F ! 1 * J ? 7 F :2F F + ! % , { O 1 R! * J ? 2X! & D 1 RBC Y ' % & 1 n& 1 SY 2 1 / - % P 1 ! )&? + 29>F RBC K % M3 ! % 2 Pass ( ! ' % , ! ' ! * /- (2 D 2 A F , 2, : 1 S 2 , CD 1 n& % 2 1 Pass ' F a (2 D 2 , ? 7 JC* I1 k! ! CD 2 F ! n ! )6F D ( 1 & CD ^ 1 + 1 % ' a - @`` mL/min ! s` mL/min < 1 - 3 2= 8 A9, 3 A; 1 g! CD 1 n& = ^1 ! 8O _ 2! 1 2;! 7 Y + = 1 ! 01 * [R< % ;2 1 ! 9 - Extracorporeal
  16. 16. (F (2 6F ( F %$@`` mL <" G ^1 $H`` mL <" S ' 1 ! 1 &2! , ' 1 1| '(2 6F = R! F < 1 7| ! Y 7 ! C? % & )6 %$r" F(A 1 2;! G ! '+2 + h * ! R f S 71 i m F 1 i, D V2 8 J 1 ! ' 2D F ;, !1 , 2 ! ' !1 S * (2F F &2 Y 4 ) ^ ;, ! y 1+ G F% 8A ! 1 ^1( ? ! 1 & CD & F !> h ' 1 * - ! F ! '1 - G 2 1 k % , ! 1 &2! ' !1 * U ' )26 F
  17. 17. !" # 1. Pineda AA. Applications of Therapeutic Apheresis. Myoclinic proc. 1994, 69: 893. 2. Winters JL, Pineda AA. Hemapheresis. In Henry JB(ed): Clinical Diagnosis & Management by laboratory Methods. 20th ed. WB Saunders, 2001:776-805. 3. Kambic HE, Nose Y. Spin Doctors: New innovations for centrifugal apheresis. Ther Apheresis. 1997, 1: 284. 4. Corbin F, Cullis HM, Freireich EJ, et al. Development of apheresis instrumentation. In McLeod BC, Price TH, Weinstein R, eds. Apheresis: Principles & practice. 2nd ed.Bethesda, MD: AABB press, 2003:1-27. 5. Corbin F Cullis HM, Freireich EJ, et al. Development of apheresis instrumentation. In McLeod BC, Price TH, Weinstein R, eds. Apheresis: Principles & practice. Bethesda, MD: AABB press, 1997:1-26. 6. Gilcher RO. Apheresis: Principles and technology of hemapheresis. In Simon TL, Dzick WH, Snyder EL, et al(eds). Rossi's Principles of Transfusion Medicine. 3rd ed.Lippincott Wiliams & Wilkins, 2002:649-657. 7. Simon TL. The collection of platelets by apheresis. Transfus Med Rev. 1994, 8: 132-145.
  18. 18. ! ! "# $ % ! ** , - !. % - / On–line & '( ) *+ 9Set5 ' ,:; % 9 7 8 '% , %6 , 50. 23 4 10 0 0 BCA @A ? - 0 - 0 , > =< + $ 0+ "# ' -) ) ? ** ', > 0I H J * 9B5 ** 0 D 0E F '? % G H -2 . M 1 ** , 78 L ? %' / ' %8K! , > 6 0 M = , % , - 0> N > J OP : %? 0 ! "# Q 3 U9T5 ** 0 R% *S - ! "# ' , > 0 9W) ( VB U *0 YN + % - 0* X 9O B O% * * T Z% ** [ VT [ %( Z V@ @ 0 P O^ 8V] !$ % & #" !$ % & .? ? 1 '% L :F ( > 0 .% 23 4 -P 8Z - F 6 - X0 9- N 5 M <P % NI 8 % '? 10 a? 6 & % _ S F - : N -` 6 % a? 6 Y % 6 6 >* 6 6 - N _? - 0E % I - N - 0 ? 10 . - ` 6 & ? ! "# U: b6 - 6 c 6 ! '? - N X0 K. % - ` % 1 Intermittent Flow Centrifugation (IFC) 2 Continuous Flow Centrifugation (CFC) 3 Affinity Adsorption Aphesis
  19. 19. -+ 6 9@ ]5? . ' ,d [1 % : e : ) + ,: ) 1 ,: *) : "# '% W[ P ' ,- ` % D $F f" 0! ( - % # 0H - H - 9 ,: ) 1 - ` ? . ' ,d [1 % % d g *h - 5 Y, % D ' ,- ` X )8 % , 0 : ^# O * ! & ' 4 ' F 0[b -N % ' - 10 M <P ' ,-N R% 6 - = H & - X0 $+X T :; & 6 *i!, : -! !4 0h -N % % 23 $< 0+! Z - ,- X 6 0+ - - X- % > =H % $< -N I% & X0 - !. 1 ' > - X % X0 ( :F % X 0h -N & !, - -N 6 % X K! 0[b ' ,-N 0+ ' # X0 G ? 0+! Z j 6 X -> ' 6 0H 10 . - % ! . '? % ' 7> 0h -N 9 ! "# k` !3 5 d <F , k` !3 X + Z` 3 - NI $I 6 : 6+! X0 :c1 -7 * - 5 ! "# I % % % X0 - 1 ** a , I% % 0 -N[ : ? . ' ,d [1 $ X k !h - -N ! . % X0 96 P % %8 9C5 X 1 - ' > # :h % 0H g I % $ <Pc ' *)(0 ! "# VC $+X
  20. 20. 2 k`% ? 0 3 0!7 $ % - %: % R% 6 -S 1 %Y ? . ' ,d [1 0, X :c1 E k L : 0* X R% ! 0[ d <F X l P 02 . R% ! ** , Y ? . ' ,d [1 : , 6 3 ' % Y N - n # _c j - 0 % :N m 6 X - 0 0 R% 9C5 10 ! +, ( % O% * ( $+X % - '( ** ', > d <F ' %8K! -N % ( Z 0 [ $ X :; * 0 Z% X 0 =< + % *-(O% * ( Vq $+X -H :; % ! ** , O% * ' ,( 9% 6 0 6 , 5 23 4 - P) D ' >c # ' X0 > o!# 8 $ - ( Z '%%p X f [P o!# &! M <P % NI _ S L '? S0 : L :h Z % X0 ?D -N %8 % X / Z 0 % p X '? % 10
  21. 21. %( Z - :N - 0? % $!h m +3 o!# X0 ' %8K! 28 , % 10 $ !+ ! "# % & 6 - % X0 1 - $I Z% ( 1 ' %8K! d <F 2 X0 + ,6 X 6 X0 Z D & - a? 1 % 6 1 X0 f [P o!# &! - 23 4 '%% N % X6X % & - 2 % X K! -N & a? % X Z D ( R% a ? ' - 0!DI , - X0 Z D ' H R% 6 10 rPX - > a? Z% H- ' % X 6 ?> Z Z% < X0 / ' - F 9]5 X0! - [P $ < : c $ % 6 -0 - F 6 0 s ' ,( 0 3 % ? Z , Z% % O% * ' ,( ** 0 & 6 *i!, % : 8 k N 7 8 $2 % $!I % +S O% * ' ,( 9 X0 % Y, G H 6 !, % X/ 8t -5 1 ' Z% % ' > ' 7 8 0+ - ** 0 % Z% d H :[h 6 !, - % X0 Z D - # E :c1 % ' ' > 6 * X 0 ! X/ YDI Z% ( 6 *i!, : , ZD ! c 2 - 6N % [E 6 - : O% * J ! 0 ' 1 [ O [E w h % % : !, ?v I m NI YDI u - % / & –. > + =" m - N =" ' - '? [ R% 7* - : ' - 0 ,p ' - X0 h 0 cx Z X0 _? - X 1 - ! . '? % * h 8 0 a? : ) z1 % 9BAµm5 : *) 9y µm5 RBC 9@ µm5 ,: "# U * h '? - '( ' ,Y N -N 2 R% 6 0) [ b *h ! "# ' 9B@ µm5 :[h - 5 0) [ b *h Z ! ' % / ! YDI $ % +S ? :[h h 1 ? ' ? -D % 7 "# - - [ 0 cx ' 7 &S 9@5: ' N 9 , 0!
  22. 22. U *X b % - : 6+! , ** 6 * N, 0 ,p ' - : & ' ,-) ) ' - $+c d% J X { [u $+X - 0) [ b *h % X / ,p G H ! "# X0 ,-) ) % X0 ' %8K! ,-) ) W) P :! $ * N, ' cx % ' % :P -F b b - , ** Z% J Fb0 |E % X/ , cx 6 p ! "# * 0 h cx % 6 6 ' %8K! F b 6 > :! X { [u $+X - ! . 0) [ ' ? % 10 ' %8K! 9@ ]5 10 !/ & $ % & 0' %& –- : '? * S [ & ' - X0 : L = } & % , > 6 ! "# - ' E X0 Y N2 0 ,- ` - % 8 : I - S0 [ 0 .% [ ' ,p ! "# -D X0 % [ 6 >* ' ? % - 1 . [ %D : L - F - XI % t F 0) [ ' ? -+ ) I X0 / = } ? % h [ ' ,p * 0! 0) [ ' ? - : 6 R% % 6 X0 ' %8K! 0 , [ 0 -D X0 % 8 ? ? 1 '% t S * ' ! '% 6 *i!, % ** ( k b ', > -N 2 +S ' ,p 9]5 s ', > -N 2 a? 1 : c # ! "# ' ? 0+ 0 P ' I [ ' ,& *+ 0 4 Z% & X ' ! "# [ X 01 ? ? ' X - X 0 [E ~ : 6+! +S ' ,p ? ] 99 ' c 8 [ 55 *h - ' b- ' c 3 % 0, ! "# '? % X 0 ' 7) [ ! "# R% 6 9@5 X0 ! . ' ! "# X/ ? ! a? X0 h [ *S & %( W[ P J R% 6 X0 1 ! - % X f [P 0 ' 7) [ - 8 R% 6 -S 1 X0 0) +) ' ,0 b % J * ' ,p , [ ^ * X # Y 0 P : [ . R% 6 ' 7 % F -[! : i # $!h 0)% 0 6 3 % ' : , > 6 J 0•3 / YDI % 0 b 6 - : : "# - 7 R% 6 0+ X 0 ' c I"b - R% 4 - Cascade filtration
  23. 23. - - L ' cx % X ' %8K! : "# 0*x ' ! "# - b X0 Y ! "# 0! YDI : "# S0 ! "# R% 6 : 99 [ 55 [ 0 P ' 7X% > 0+ ** 0 O - 0? 0! !D -E2 - 0)% X0 % X 7) [ -[! ,' ! 0[P J ** O ' ,6 e % # 6 X0 ! "# % v % : 8 $g * !, : ' ,' ! % ! ' ,' ! , H 0•3 !* 0 48' 9 3 : ( 3 4& 567 21 % '% - ! X ' N # ' ! "# 1 + :[h - ! "# ' ? 0 P =^I : - N ' ,-* ?, % E - 6 ?> 3 ? D ' 1[ ', -[! 5 ! "# *, $ +c 03 H ' ? ! - : 6 ,R% 6 > 6 : -* ?, # 0[ . ' 7X% -N 2 0)% ** 0 ' 1 [ ' % I 9' 23 : ! "# 8 ' ? ! $ h - 0 ,' ! ' ,R% 0) [ b *h 8 - : & + 0 -[I $ X [x 0 P =^I ' ,R% % X0 h 0 P =^I > d" ! "# X0 & + ! "# $ % - c1 ' %8K! ! "# 3 10 =^I & ( ) ! 0+ ? 0 ! X G H - X - d< 0*3 X0 9 ( 5 ' > 10 G ? ! - k D : 6+! $!h 6 10 . ^ $I :F ! "# - 2 % X 8 d < 0I X k D % X h 0 P =^I > k ! N ! "# 0*3 5 X On–line < 6 $ 1 ' %8K! ! "# I % 0*3 5 X Off–line $+X - 9 1 f [P 0) [ b *h I% > ' # 1G ? ! - % 10 . ' $!h :F I % 9 0 - * 8 % X ' %8K! ' 3 X 0 € X - 0 P =^I ' ,R% J !A & ;< => & ' 7) +) - 0 - : ' 0) [ *, $ +c a? A 0 [ 6 e% # . IgG4 % IgG2 IgG1 ' . d < 6 e % # 6 9q5 d < & ( ) ! x < IgG A0 [ 6 e% # J % 9y5: u IgA IgM IgG3 8d< *0 q +[ –A0 [ 6 e% # % C % 18 – A0 [ 6 e% # % 5 - Staphylococcal protein A-silica(PAS)
  24. 24. ' %8K! 8 ' ,6 ) [1 ! % X h , ! ' ! "# J % , $ . % X0! ' > J X & # PAS 10 d < ' ,6 ) [1 ! =^I 9q5 ! Q 3 ! "# ) T 0 7* , ^) X 0! 0 # X0 , ' - D* ^ ', K ht - ' d% %0 + % on-line R% ! "# - 2 '% $!h ' X0 : , Z% - ! "# % 0 + X J X - 0 >*, ! "# c . $!h :F ! "# O [E YDI -+ 6 : ' d I d% -+ ) I X0 + 1 d< 0X % 18 – A 0 [ 6 e% # $!h YN + - : 6 2h +[ – A 0 [ 6 e% # $!h YN + : 7 8 :X % ,6 ) [1 ! 0*! ' , +[ ! =^I - 8 ' ,6 ) [1 ! :X %"h 6 : i# X :X ' , +[ ! % ,6 ) [1 ! ? $ #0 ? R 1 %"h - 0 * N - R% 6 0 8 0 7* - % • N : 6+! 10 ? 0*! Y * D +[ –A0 [ R% 6 :X 0 ^# + ' -* d" - 0*! Y N n # - U 10 b YN + @ 6 YN 10 0*! O &S 0*! ' , +[ ! % Ud% YN + : N 0*! O d - -D % :N , +[ ! 6 =^I - . d [% ) + - _, ' 0 8 (0 8 - 4 , +[ ! 6 =^I 0 _ ? ' 0 8 - (0 8 10 K 0*! O % b ![ ! N+ A 0 [ 6 e % # - IgG d < b UZ% YN + : 6+! '% - ! D 1 - , ![ ! ' ? ) ^#0 1 0*! Y N Xd3 0H - 0* e % # X T % B ' 7) [ A0 [ 6 e % # UZ YN + X 0*! Y * %T B ' 7) [ g+ : 6+! ? 10 $!h y : 8 % ~ ', - Z% 2 ITP + [ VA‚0 [ 0* e % # 0* e % # 6 *i!, : - 1 . FDA v % 6 Staphylococcal protein A-agarose(PAA) 7 Idiopathic thrombocytopenic purpura
  25. 25. ' , ** 7 ' - 0 ! FDA t % 18 V A ‚0 [ AV0 [ „ 0* e % # t - 0 ,' ! 9ƒ5: X * N, % : 8 & d% c FDA t *, % X0 / 'A & +< / & A B C= 3 #" ?@ *DEF(? , PAS Column(Prosorba) PAA Column(Immunosorba) Antiglomerular basement Chemotherapy-induced membranes disease thrombotic thrombocytopenic (Goodpasture's Syndrome) purpura (eg,mitomycin-C) Wegner's granulomatosis Platelet alloimmunization Focal segmental Solid organ malignancy glomerulosclerosis Systemic lupus erythematosus Paraneoplastic syndsromes Myasthenia gravis Paraproteion-associated polyneuropathy Acute demyelinating Autoimmune hemolytic anemia Polyneuropathy (Guillain-Barré syndrome) Humoral rejection of solid organs Off-label uses not approved by the FDA. L8 6 X%J : !, ' 3 0 L A0 [ 6 e% # 6 e% # 0X 0 L : % J m 0 U * h % 18VA 0 [ *8 ZD †TqV@A w h 6 N , … J 7 0 [+ "•h * h + [ VA 0 [ 6 e% # 0X 0 L8 : X ! †@yVqA% % N , & ( )8 ' ,_* % 0>* N , … J 7 )% U 9BA5 X R ?1 ! †yA % * Z D †@] ,_* % 6 ' 0 6 e % # - IgG d < X l -+ E !, X 0 3 w h 6 % ' ,YN + d 3 ' ? % % ,_* % 6 ' N X0 ![ ! N+ - D* A 0 [
  26. 26. % 01 )8 $ X 0) ! I $[h : - $. ! - C5a ![ ! X ,_* % c * N, A 0 [ 6 e % # X - NX ? % 6 N % k .3 D 0 d H - :h BVT % I % *, 0 '% # :h & % W X R ?1 + [ V A 0 [ 6 e% # d j -[! X ' ,_* % : U * h R% 6 f X ' ,_* % rPc ' >) 7S ' -* ' ! X Y % % j ? s% h % : ) + % 0N " 8 !; 8 HI 3 = C; < G 8 3 4& 567 ƒ ' $!h 6 X 0 ? LDL 8 - Z LDL 0 P =^I ! "# Q 3 *, 0! n # 0 % - - > % , ? % > !, 0[ 0!)% N[ , LDL d% N[ ' N # 0 d % [+ % 8 K N - D* d" 6 %4 X0 ' ,' D*, K ,Z ?1 X 7 d% N[ >!cS _, LDL 8 Z D d '% !h d H _ ? % R % $!F _ ? ' % s% h 3 4 : N# ECG X 0 m LDL 0 P =^I ' ' 3 ' ,R% 9BB BT5 , 0 $ +c ' ? 6 1 ? 0+ LDL : BA- 1% - < ‡' L ! "# d% R% - 1% - < : ^# + LDL =^I ' [ 6 $ ) 6 !, - : ! "# *, d" % X0 $ % 6 0 [ ( G H ! "# h , 0! h LDL - - : &S ' I - 8 ' 7 - '> [ - )% ' ! "# - : N HDL †]y % IgG †qƒ 6 )8 †ƒ@ '% I X - < ' ! "# X0 0 -> (* †‡A IgM †‡T LDL †‡] [ $ 2 : ! 0)% X0 LDL d% N[ 07 c : - D* ! "# Q 3 -N 2 - 1% [ , 0 _, ! HDL 8 Low Density Lipoprotein 9 Secondary plasmapheresis 10 Double-filtration plasmapheresis 11 High Density Lipoprotein
  27. 27. BT R% 6 : 6 ,t / LDL O LDL 8 Z% R% ! O LDL X0 %? ! "# - %6 , X $ ! "# =^I ? ) t % X O^ ! "# 6 , X0 [ t 8 #% & ~ X0 1 ! - % - c1 f [P 0) [ b *h ! "# 10 †Cƒ % †BC - (* % HDL _, % †@A _ LDL d% N[ _, 0 : c N % R% 6 X 0 B@ ) N O^ LDL =^I Z R% : X & + k" . - 0 ! "# % 0 + LDL d% N[ =^I ' k ! N ) J X # X0 1 ! - % X f [P 0) [ b *h X o!# d% d% N[ =^I ' d Aˆy NaCl d% % X : , Z% - d% D = < ' % - c1 # 6 ) d '% I 6 , 8 3 X0 - NX LDL & Q 3 d LDL d% N[ †C@ _, > c Y N 6 '% ,0 X0 8 : HDL d% N[ †C % ( * †@q _, ? % ! "# YDI B] ' , 7 '% I % YN 6 : 0*! O^ R% LDL =^I 8 R% %0 + : N LDL 4 - * 1 d [ 0[# ' ,' 0 8 - ` % d < % 18 6 X0 ' Z% *0 h & ! "# -+ ) I s * !, c ,0 X0 z - d < LDL =^I ' & [ ˆ6 N [1 z R% : HDL _ ? % BqC mg/dl ?z - d% N[ { I R% 6 0 z *, : X |4 m LDL 8 ' ,R% J T !X d% F ` ' HELP % ) N Y N t2 s ' ,R% LDL d% N[ 07 c _, *, c > + ,R% 6 -N 2 9ƒ5: FDA v ? ' ! _, > d I 6 h % ! "# ' ? % HDL ( * Lp9a5 6 ,_* % :h X 0 ! "# Q 3 -N 2 ! "# ' ? % (* HDL ** 6 3 J !D $ h 6 *% Z D 01 % -* ?, ‰ F) 0)% : - c ,Y N X 0 0b Y N 12 HELP: Heparin-induced Extracorporeal LDL Precipitation 13 Dextran sulfate absorption 14 Immunoabsorption
  28. 28. %O K - X 0 "3) 3b XR S : 6+! & N[ ! ', - * d< 0 ' ,6 ` !3 $+c 6 10 8 % '7 )3 , 6 - ! 0 X0 d * %0 d xl ' ,d N '% b ' -c X ' , 7 '% I d" ! "# h : 6 *S 6 *, 0! n # 0•3 -S 1 % 0b 0 L R% 6 : R 7 Z d xl X# : ' 1 [ $ .6 ,6 0 _# - X0 & ( )8 ' ,_* % S !
  29. 29. *"-#")( LDL : = CJ&K BK #. ?@ Method of Substances Removed LDL Advantages Disadvantages Removal Dextran Binding to LDL-56% to 65% Column can - Requires sulfate dextran HDL-90% to 30% be plasma (Liposorber sulfate based Triglycerides-34% to regenerated separation LA-15, upon 40% - High Kaneka, electrical Lp(a)-52% to 61% hematocrit may Osaka, charge interfere with apan) plasma separation HELP(plas Precipitation LDL-67% Removes -High mat Secura, of LDL by HDL-15% fibrinogen hematocrit may B.Braun heparin at an Triglycerides-41% interfere with Medical, acidic pH Lp(a)-62% plasma Bethlehem, separation PA) -Complicated system Membrane Separation LDL-56% Removes - High differential based on size HDL-25% fibrinogen hematocrit may filtration by filtering Triglycerides-49% interfere with apheresis plasma with a Lp(a)-53% plasma second filter - Loss of Some albumin, HDL, and IgG Immunoads Immobilized LDL-64% Column can -Exposure to orption(plas sheep HDL-14% be animal maslect, apolipoprotei Triglycerides-42% regenerated proteions Teterow, n B-100 Lp(a)-64% Germany) antibodies Lipoprotein Binding to LDL-61% Plasma Column cannot hemoperfus polyacrylate- HDL-30% separation be regenerated ion(DALI, coated Triglycerides-42% is not Fresenius polycrylamid Lp(a)-64% necessary HemoCara, e beads based Redmond, on electrical WA) charge
  30. 30. / LJ 7; M ! ** , ' ! "# % RBC YDI 6 3 ! "# 0 $ N 0+ 9 - $< ' ,-) ) % > 5 / ? ' % F * - - : X0 Z D 990 Š 55 6 3 % 8 w h % N , ' 1 [ :7 YDI $ †BC / YDI D ? 0! . ' , h"H # - Z 1 0 $ YDI 6 3 ' - 9Bq5 * N 0 6 . % ` 3 ' 3 X0 Z D > t F % > - ! - f 78 %"h ' > % % % * m + % & * N, m * 6 !, - Y, % , 0 S: :N m ,: YDI u :[h - - ) :N, Y, . u $ X 03. % I ! 0 "•h k X % 03. % ? _ sS 0[ YDI R% ! ' I .Z - 0 7) $+c 6 - * 0 6 !P 9By5 * 0 6 $ YDI 0) . $ . 6 !P % X0 3 BV • 9 Aˆ@qq‡ ŒH 5 ‹ 9 AˆA@TB‡ ŒW 5 ‹ AˆAqA]B BV • 9 Aˆ @CqB ŒH 3 5 ‹ 9 AˆA@@Aƒ Œ W 5 ‹ AˆBƒ@@ 9 # - % UW Ž* - . UH ) - YDI UBV) * TBV( /?3 / L N J 7 BO # Patient Habitus Obese Thin Normal Muscular Rule of Fives* ml of whole blood/Kg of body weight)(Bƒ) Male 60 65 70 75 Female 55 60 65 70 Infant /child - - 80/70 Nadler's Formula (for adults)9B‡5 Male (0.006012ŒHeight in inches3 )(14.6Œ Weight in pounds)+604 Female ( 0.005835ŒHeight in inches3 )(15Œ Weight in pounds)+183 $ YDI †BC - / YDI % F ' - 9TA5 ', GH BAˆC 0*3 BAˆC mL/Kg X % / - : D - 0 2 g I ! ** , ' ! "# % RBC YDI : ! ** , % Z 1 [ , ' - 0 0 9TB5 X0 D* : !, % $ YDI m
  31. 31. PV = BV [1- (0.91) (0.96) VCH / 100] PV: Plasma Volume BV: Blood Volume (liter) VCH: Venous Centrifuge Hematocrit U9TT5 %? ' d PV = TBV × (1-HCT) PV: Plasma Volume TBV: Total Blood Volume ! "# Q 3 -[I & - 0!DI 0*3 Q 3 YDI - F * - 0 ! "# YDI U9TB5 X0 R # EV Q PV PPVE Q 3 ! "# YDI & d 3 - 0 3 3 :PVE (plasma volume exchanges) X0 ) NI Q 3 YDI UEV X 6 ) - : 0 ? - ! "# % 7) [ $ X X/ YDI $ / RBC YDI % 9 * 0 Y, YDI 6 [x - 5 / - > ', N -S , : * ! : !, - * # -) ) % d Z - : 0? - ! - , RBC 1 _# ' c $ X ! ! : !, : N _ 0F4 % H - 0 / ' , RBC : N 6 * 1 .R # X TBV †BA : 6+! / $ YDI d g ' X / Y, / YDI : > Y ' , RBC YDI † BA _ -+ ) I $g Y N 0 * $ % % ' * J 9Z% O% * 5Y N J m 6 *S *0 u -[ % - & ** Z 1 / RBC YDI % / $ YDI ' : . 0[ / RBC YDI † BC –TA / $ YDI 1 9T@5 * % D 0[ YDI †BC ? c _, ' 1 [ ' 9` : !, ' ! dg *h - 5: †BC ! 1 : Z`' v[ v ) N 6 ) d [F ? D 0.% h $ YDI _, d - / RBC YDI X 6 # ! : !, †BC ! / $ YDI Y "h ‰ F) k 2 . ! ! %D / RBC YDI $ †BC : 6+! 0.% h
  32. 32. X0 : "h %-X ' 0 [. "+c ' -iP ! 1 X :F 0N , / RBC 0!DI 1 9 •N - ' 0 0>* 5 X 6I : !, - F R% & * N, : "h % - d H d N1 ? ! U: * ZD V*RBC B 8 J 7 – /?3 U L RBC J 7( ÷ TBVT P "SSQ ?+ ; 7R C X 0 & )%%? : 34% & * Z D d" ! 8- , 0 c d 6 ' k ) x : : "h . ! % †T] _ '% N * ZD 6 I: !, 1 9@5 $!F - . 0 I 6 ? 0! 8 - " : "h . ! , P ( N ZD - *X 0 ? †T] ! : !, =? & ' [x ` :h 6 0 ` :h - ! "# * -!, _ % : 0 $ . 0E F % G H 9Bq VBƒ ? 5 j ? % & 0 0E F %- 0 Z h b -S 1 X0 d - 8'• ', % ' c, |E _, ! 5 ! :c 1 &! - ' % :c1 _ ? m % 0> N S % - X 0 "•h |4 % W34 - 0 7 8 % ! ' +!, Z h c, x E :[h - 0 , : '? % ' ^> - [x 9 X0 $+c 0+ ! 6 ?> '> ** , + b '? % ' ' > • *, : 6+! - : ( )8 0E F & v # !, _ # d [ :X 6 X0 1 h- ' %: *, - - 0 E - : |4 % X m 8 * • $ 0, 18 - : 4 *, % - 1 . - :. - 0•3 5 ' % ' , :F $ . - 0* ? ' ,' ! 0 ! "# : 0 $ . Y, ) x - : 0E F ' , % : )% Y, 9 .% $ X : '? %- 0 - -' 8 $!3 0 m -0 ! 6 *i!, ICU _P ' N ! %&* ? 6[ 1 Z * '? % ', ' ^> k` !3 9TTP 5 ! "# Q 3 3 - 9T] TC5:
  33. 33. E _D* # % 0E F %G H ! "# Z D + - ' ', 1 . * 6 ' * '? % 0) ! I 0I H : g c ' % ^#= E3 '? ' , % ' 6 % BC 0) [ ** > t X D 0 * c :F Z • 0 , 6 *S X ' D ' % :P ', 6 * X0 #" S KE. d" % c * X 0I H ? ) 8 ' •% E - 0 - 0 % Hickman ! "# % ? ) !, Premcath. 5: * ! . 0 9T @59Quinton – mahurkar %Neostar pheres flow ' 1 . $F : h % 6 ) - P) D ' 1 [ ' , G. :. ' 6 ) $ - ! "# Q 3 Z ! # -[b " -* , d [F G ? : Y7 8 ** d 3 ' ,% G ? - P) % b : - P) D ' 1[ 6 ) D ' . % - P) X ? ) - D* k` !3 - P) '% I 6 ) - ( * ! "# 9Tq5 X0 $b I w h % "+c 6 c % 3 '? ', E % : Y7 N '?z ' , ' ^> 9Ty5: , 6 !, 0X ! "# 90 . = %5 SVC 0[ ` 1%( % % 6 %" O z • - :X :. m ! % : ? [, • 6 1 . b X c : ? [, %% j - D* 0 - * 0 % 9PVC5 0*E m - 4 % 0 [. 0! 8 SA node % 0X ! 2 N 0 X0 0! 8 % - D* - 0 [. & F 9Tƒ T‡5 X % % 90!) , 0!N[ ,5 0 )% +) u 3 & F 0X Y 2 N x & X ! [. : ? [, $ - 9 X0 ? Y N[ - - 5 2 %"h X ZD 6 %" O '? % ' ^> # -* -N . 0 1 % Xp Z h 90 . = %5 SVC • ' 1 . * !H d <I Y, X , 0) 8 % *# !, - D* 0 - t 6 %" O 9@ Tq5 1 $b I * !H , 8 ' 1 . $F 6 7 '? % - 3 - Y !< l P $ . 0I -E % ' % 0 X :*X & - 3 ! 0•3 ' 9@5: 1 Y !< M ! d ! %% X6 0 . V0 . - I : # - 6[ % [ 0[# #& * 15 - Soft -walled
  34. 34. Z ` * - 0` H ' - ! "# 0 ' ,Q 3 b< X0 $ . 90 F = %5 IVC • - d ! - I ', *S , 9Tq5: % _ % - , & g I - ' E : 78 0` H K : h % 10 0, 1 0 I: % F % X ' N ! ! k *!4 % X & g I - ' E * N, * ! 0` H ' , ' 6 %" O ' , ! 8 3 - % X . 0 Y % & g I b 8 X % ) 1%( % '? %- 0 :7 1 : 03 H ZD ! "# 0 , 6 - ) - 0! c ! / , p ' 1 . $F : h 1 ,s -[ - *.-(= ? =C & W M #- ?@ Catheter Advantages Disadvantages Site Femoral Placed at bedside Increased risk of infarction Requires least skill to Decreased patient mobility insert Risk of kinking Hemorrhage easier to Risk of arterial puncture* control Increased risk of thrombosis No risk of pneumo/hemothorax Subclavian Patient comfort and Hemothorax/arterial mobility puncture Long-term placement Pneumothorax Requires greater skill and technology Cardiac arrhythmia(position of tip) Subclavian vein stenosis Internal Patient mobility Risk of arterial puncture* Jugular Long-term placement Cardiac arrhythmia (position of tip) *Using a cutdown technique instead of percutaneous
  35. 35. !X3 + 1. Hodgson WJB, Mercan S. Hemapheresis listening post: optimal venous access. Transfus Sci. 1991, 12: 274. 2. Winters JL, Pineda AA. Hemapheresis. In Henry JB(ed): Clinical Diagnosis & Management by laboratory Methods. 20th ed.WB Saunders, 2001:776-805. 3. Hillyer CD, Silberstein LE, Ness PM, Anderson KC. Blood banking & transfusion medicine.Basic principles and practice. 1st ed. Churchill Livingstone, 2003:509-518. 4. Burgstaler EA. Current instrumentation for apheresis. In McLeod BC, Price TH, Drew MJ(eds). Apheresis: Principles & practice. Bethesda, MD, AABB press, 1997:85-112. 0+X?# d2 d b - * / ' !I Z ' P Z ' % >*) ' , U 8 0S Eh VC y@qVqƒy-F b Z% [ d2 6. Matic G, Bosch T, Ramlow W. Background & indications for protein A-based extracorporeal immunoadsorption. Ther Apheresis. 2001, 5: 394-403. 7. Pineda AA. Immunoaffinity apheresis columns: Clinical application and therapeutic mechanisms of action. In: Sacher RA, Brubaker DB, Kasprisin DO, Mc Carthy LJ(eds): Cellular and humoral immunotherapy and apheresis. Arlington, VA, American Association of Blood Banks, 1991:31 8. Mcleod Bc. Therapeutic apheresis: A physicians Handbook. 1st ed.Bethesda. AABB press., 2005:163-180. 9. Levy J, Degani N. Correcting immune imbalance. The use of Prosorba column treatment for immune disorders. Ther Apheresis Dial. 2003, 7: 197. 10. Huestis DW, Morrison F. Adverse effects of immune adsorption with staphylococcal protein A-columns. Transfus Med Rev. 1996, 10: 62-70. 11. Bambauer R, Schiel R, Latza R. Low-density lipoprotein apheresis: An
  36. 36. overview. Ther Apheresis Dial. 2003, 7: 382-90. 12. Bosch T, Wendler T. State of the art of Low-density lipoprotein Apheresis in the year 2003. Ther Apheresis Dial. 2004, 8: 76-9. 13. Parhofer KG, Geiss HC, Schwandt P. Efficacy of different LDL apheresis methods. Ther Apheresis. 2000, 4: 382-5. 14. Hershkovici T, Schechner V, Orlin J, et al. Effect of different LDL-apheresis methods on paramethers involved in atherosclerosis. J. clin. Apheresis. 2004, 19: 90-7. 15. Matsuda Y, Malchesky PS, Nose Y. Assessment of currently available LDL apheresis systems. Artif Organs. 1994, 18: 93-9. 16. Standards committee of the AABB: In Menitove JE(ed): Standards for Blood bank and transfusion services, 18th ed. Bethesda, MD, American Association of blood banks, 1997. 17. Mollison PL, Engelfreit CP, Contreras M. Appendix 5 in Blood Transfusion in clinical Medicine. 10 th edition.1998:561. 18. Gilcher RO. Apheresis: Principles and Practices. In Rossi EC, Simon TL, Moss GS, Gould SA(eds).Principles of Transfusion Medicine. 2nd edition.Lippincott Wiliams & Wilkins, 1996:537-545. 19. Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults. surgery. 1962, 51: 224. 20. Standards committee of the AABB: In Menitove JE(ed): Standards for Blood bank and transfusion services, 18th ed. Bethesda, MD, American Association of blood banks, 1999. 21. Buffaloe GW, Heineken FG. Plasma volume nomograms for use in therapeutic plasma exchange. Transfusion. 1983, 23: 355. 22. Kaplan AA. A simple and accurate method for prescribing plasma exchange.
  37. 37. ASAIO Trans 1990; 36:M597. 23. Jones HG, Bandarenko N. Management of therapeutic apheresis patient. In Mcleod BC, Price TH, Weinstein R, eds. Apheresis: Principles & practice. 2nd ed.Bethesda, MD: AABB press, 2003:253-282. 24. Rizvi MA, Vesely SK, George JN, et al. Complication of plasma exchange in 71 consecutive patients treated for clinically suspected Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome. Transfusion. 2000, 40: 896-901. 25. Annane D, Baudrie V, Blank AS, et al. Short term variability of blood pressure and heart rate in Guillian-Barre syndrome without respiratory failure. Clin Sci(Lond). 1999, 96: 613-21. 26. Gilcher RO. Apheresis: Principles and thechnology of hemapheresis. In Simon TL, Dzick WH, Snyder EL, et al. (eds). Rossi's Principles of Transfusion Medicine. 3rd ed. Lippincott Wiliams & Wilkins, 2002:649-657. 27. Spindler JS. Subclavian vein catheterization for apheresis access. J. clin. Apheresis. 1983, 1: 202-5. 28. Sutton DMC, Cardella CJ, Uldall PR, Deveber GA. Complication of intensive plasma exchange. Plasma Ther. 1981, 2: 19-23. 29. Huestis DW. Risk and safety practices in hemapheresis procedures. Pathol Lab Med. 1989, 113: 273-8.
  38. 38. %"#$ ! " ! "! Plasma products by donor plasmapheresis Therapeutic plasma pheresis $ # & '# Plasma products by donor plasmapheresis %( ) % & '( )*$! + ! ,-. ! ! ! / ! "! 0 ! "! = 1 < .! 0' 6 23 4 5 6 74 89 ! :; ' 1 % 0' 6 ' > ? 0@ ) + 0@ ! % 1 ' 6 A B?$! ,. -+ % * C D $ 6 74 89 @ ) + @ ! =@ ! . &:$! $ $ E % * @ F 8?E! G 9 ! ' H + 0 B;$! L ! M E N ! $! =@ ! ? I !J ! ! %H K 74 89 ! )? ! ! ? + ! ; D! " Q? I" + 074 89 P D C K + 6 "O?* =@ ! ! I !J ! ! 74 89 @ ) + @ ! 0 " +! "! C F C $! 9 , #RRR A ! 8?E! H ' 6 ' > ? * @+ K T + @ ! !J -U3 0RBC T $ 6 74 89 ' > ? = $! S L =@ ! 1 " J" I !J ! V 0 $ 6 74 89 @ + I" + W V$! @ 74 89 7 H LKAK 0 $ ! 4 J" XY3 Z + 74 89 RBC L! RBC RBCP ] $ 1 [ 1' >? I !J ! % B J" I" + V 0 * C ! =^=…… @+ ! " =^ @ ! b 1 %a` 1 "_ @ 74 89 ! )? ! ! ! :; '( )*$! ! W 4 % + c ? ! +! "! ? + ! ; D! $ V1 $ !! " +! "! ! A 89 ?3 d ' U ! # A 89 " P D C K @ ) + ?3 A ? + V ?$ 74 89 4 @ ) + e ! $ ? ! @6! U 74 89 f
  39. 39. '! 'N +! "! C?6 h " " g 'N +! "! ) "I +! I" + i % + c [ 74 89 $ 6 74 89 P D j %7654 - 3 1 $ 2 + 1" - ./ 0 *#, + *# * 765 - ./ 0 *#, & + 83 2 + Procedure Instrument Primary PLAP MCS +(LN9000), Spectra, Trima, CS-3000, Amicus, AS104 PLAP + Plasma MCS +(LN9000), Spectra, Trima, CS-3000, Amicus, AS104 PLAP +RBC Trim a 2RBC MCS +(8150) RBCP MCS +(8150) Plasma PCS-2, Autopheresis-C Granulocytes MCS+(LN9000), Spectra, CS- 3000 PBPC Spectra, CS-3000, AS104 Secondary Cryoprecipitate PBC-2, Autopheresis-C Cryoreduced Plasma PBC-2, Autopheresis-C PLAP%Plateletpheresis; RBC: Red Blood Cells; 2RBC: Double Red Blood Cells, RBCP:Red Blood Cells plus Plasma; PBPC% Peripheral Blood Progenitor Cells.
  40. 40. % & = $ N ! E " 23 "@* ! C " 2 k @9 0 ! "! ' &-. ! =@ ! W 4 % + ' 6 ' N +! "! ! + @ ! ; % 1 0W 4 7 ; %E! K b 1 W V$! +! "! 2 k = $ ? D? ! Z6 ! "! + ! !/ ! "! P 86 Z6 'N +! "! _ l W F M . ! 0' N +@ ! Z6 O 8 = %E $ n1J / ,-. ! @ ! CU 0 ! 7 ; W V$! 3 0 U1J mY l6! ! 0n1J / ' 1 ? l ! +! "! = 1 o 8 ! "! ! 3$ ? l = $ : ! ! &?+ $@ L 0 ?K! 7! Z6 %K! -+ ! % + " N ! "! ! W 4 ' ! I , ! + @ ! B E egpfg K W V$! 7 A . +! "! ME J $ $ C! = 1 0@ ! B E qp # K +% +'6 0 ABO/Rh%r 1 1 @ ! r6 +! "! ! 4 ; + 3 = ! -H K 0^ -) RPR 0 HTLV I II pAb 0HIV 1 2 Ab 0HCV –Ab0 HBs–Ag0HBcAb =^ 1 0^5 6 ! ?$ 2 k ALT ' N +! "! = ! 2?* ! "! 7 ; ! ; 0 +! "! A &E " ; ! :; %E! K = $ ! "! A ? g ]+! K A & #f $! ?)" 7 ; ! ; ]+! K C m " 0 1 @F fq ! ? + &$ *-D $ -H [ ]+! K ' U ! * B + =^# 1 ^ ? # f ]+! K [ =@ ! ?3 0% + ' 6 ! "! 1 $ U k " 0 + ! "! 0 ?)" [ " ! I %H! N! ! "! ?)" [ " ! ? + %H! ! +! "! N! = 1 % + ' 6 ! "! " ; D! / C; $ t! U 0 1 H 6 " ; D! 1 $# U s " 0 $ A ; U 'N " W W C u %E! K U ! D 1 ; n1J W W Cu @9 ^ &U [ " KC ; $ %H! 0 1 igr/dl ' N +! "! $ W J ! =^e $ N ! E v + '( ) $ ! ?U ! _ C & 0C & ' 1 % & ! 1 6a P& +C + ! K 1 Infrequent 2 Frequent
  41. 41. ]+! K ' 3$ D $! 0 ?*" ^IX ?+ VIII ?+ 0 %6! C -N $ ! =^ $ ! "! % + iRRcc " ?)" OVK M E A ? + @* $ C J2 D 7 ; ! )? ! $ t4 ; ! "! 74 ; M . ! + 0@ ! W 4 ' 6 OVK 1 Q w ! F ! N -D ! ' ! 1 x 6 &$ Ny " . -+ Z @ ! & 9 % E -+ A H! +l = 1 ' 6 OVK %+ z g ! I ' ! x 6 ' 6 OVK % ./ 0 & & " 1 b $1 O *B -+ N ! "! 74 89 e V 96 f P& 9 (FFP 5 :; & ! D' !% +' 6 P D ! @F i–q ]+! K + @ ! % + ' 6 P {JD 0FFP 7 8 ^ ) ! 7 8 $! . =@ ! 1 V t ; A D= 1 P D ^ " RBC ?+ W| t ] [ 0 " ' D ^ ! " RBC RBCP 7 8 $! +! ! VK ]+! K g b " ' 3$ 0 1 P D +! "! @ + " ' D 765= *>#'- ? 2#@ ! & 1 ) 8< 2 + Donor Donor Maximum Absolute Weight Hematocrit Red Blood Cell Maximum plasma (Ib) (%) Volume (ml) Volume (ml) Men 110-129 38 185 450 130-149 38 195 500 150 38 210 550 Women 110-129 38 180 450 130-149 38 190 450 150-174 38 190 500 175 38 200 550 3 - Fresh Frozen Plasma FFP 4 - Source Plasma
  42. 42. '! U ! - D != ! !J % + ' 6 ! %H K FFP * B 1 FFP ?U[ + " K! ! ' } + ,*+ " n ! ! iRR– jRR K g • O VK ~'! F ! OVK W + % & % + ' 6 ! %H K FFP B 3 ;? " " $ N 7 V I" + 0O VK " K! C ! = + V '! € ; ' D A ] '! F FFP ! 4 "OVK $ + @ ! $! ?1! )? ! + 4 89 '! _ C!n + C! F =^ $ ! TTP6 ?& ! %H K FFP =^f ! I !J ! ! IgA E FFP AB N FFP $ ?*" $ =@ ! 7 )? % + ' 6 ! %H K FFP X 6 89 7<5 - . B#, $ C & 8A 2 + Whole Blood Apheresis Red Cells Derived Fresh Frozen Plus Plasma Plasma Volume(ml) 200-250 500-600 450-550 Plasma (%) 80 90 90 Anticoagulant 1:8 1:16 1:16 ratio Anticoagulant 3% citrate 4% sodium 3% CP2D type citrate Citrate content 0.60 0.40 0.30 (g/100ml plasma) Adapted from Gilcher) 5 Jumbo Plasma 6 Thrombotic Thrombocytopenic Purpura
  43. 43. C! B;$! L K ! " X 6 ! ?3 '!J D ^ % + ' 6 ! %H K FFP z qR % B ! %H K FFP z•R 74 89 2 1 ! W4% + c n = 1 7! ? J+ -N ? + '!J KC m "= ! 3 2 " ?+ & + 7 1 ]D D + @ n . $! M J ?1! $ B;$! @ ;L ‚ 0M J A &$ $! A *N J '! B;$! CU ƒ* C ! 0@ ! ? + ! %H K FFP D WBC @+ ! ; = 1 / %6! ? U !JD! "C + ? ! ! %H K "I +! I" + @ ! =^j0q 1 O $ N ^Passenger * "@ U ! %H K ' ?} ! + V ?$ 0 ! %H K @ ? } !+ = @ 0 ! % + ' 6 ! %H K OVK ! A ; VK & k + j ME $ ^d. ! + ! RRcc K VK _ C ! @ @? } !+ 7 H % + ' 6 ! %H K ! + U K =@ ! M J d a % E $ ?1! $ ' 1 q $M J ! I ' 1ME ?1! g– #R A ; VK n36 !+ =^• ! € ; C J2 D P '! F ?1! fRR cc K VK 0 ! + E =^ R ! + TTP ?& '! 0 $ % (Source Plasma ) D@; & 0C & $ ! x! Y? ! % E 74 89 !+@ ! 0P& 23 4 0 " 23 "o ; B;$! " ?+ " ?$ * + 0 "C -N $ ! = 1 PE! )? ! '6 • % F C ! k D! A &$ + @ ! A ; k C ! _ C -N $ ! J V '8 ! ! $ H 8?6! "C -N $ ! ! = N 7 H !J K ?1lN ' *+! ? ! ‚! @ ! CU + @ ! ^C -N $ ! K L 0 „$ &-. ! ! "! % …! ' D 1 $ ?$ 7 Wet cryo 8 Dry cryo 9 Passive Immunization
  44. 44. 7 H $ 1 (! ? $ ?$ G 9 ! ! ! C ! = $1 *+! $ = 1 )? ! "C -N $ ! x! Y? ! @ D $ !0 $ B ? ? *K ! "I +! V t4 ; + @ ! D O" ^ & ! $! K S $ Ig ! , k = $ 1 RW %7665 * F $ G 1H $ C & Ig E) 7 Anti rabies plasma 5 &1 B# I & / ' 1 JN > ! *+ ! ^ HRIG $ *$! " C -N $ ! ' ! " ^ ! ?$ I" + ' *+! W F C ! k ^ " '! K 4 ? 0 " L C*+! C -N $ ! , + = ! + 0 " C*+! J V O6 ;L = + V! + ]6 " ?$ ! ? } 0 1 *+! #qp fpjpepR " 0 " ' !} " „ ! 1 V ?$ ! $ B V ! ! ' .! A 8K ?$ 0 1 l6! " ! $ ! "! 0 1 H O %H! 0/ ! 1 ' ! ! 7 H = N " L H 8?6! C -N $ ! %7 TIG 5 B# I & 1M J '6 D O ! O ] 6 ! ^TIG $ *$! !J+ C -N $ ! @ ! W -; $ ?1! $ D ' *+! „B + ! TIG =@ ! ‚ * ! TIG = 1 J V O6 ;L "' !J+ C*+! ! " 0@ ! † ]+ O6 !E ' *+! @9 + $ &-. ! ! $! 1 *+! !J+ L ?1lN + ! ! = 1 ?$ ? + B D ! 0 $ N %B4 I B# I & fq . ]+! K B @ }" > C ! k „ D! ! B @ }" C -N $ ! 1 +a O" @F j# P 6 = 1 J V @ }" C*+! ! " > ! @F HBs Ag '! ! ? '! ! $ C m " =@ ! ‚‡ 0 1 M J P [ " ? 0@ ! C -N $ ! = 1 J V C*+! ! " 0 ! $ ! @F # . + ! + @&] B @ }" 9Z '( ?$ -F ?$ ! 4 F + ! ! ! B @ }" H 8?6! = 1 0 $! 10 - Serum Sickness
  45. 45. % Rh J H '# # !#*# ! 0 $ ! @&] Rh C D + ) Rh '! ^W N A } Rh L C -N $ ! V + 0C D /B ' ! A &$ C D D '( ?$ @ *K V ! ! N -D C D /B ! 23 ! = ! + 0 1 @&] Rh "C D ; U "/B ! 1 W V$! K %6! ' 6 A B?$! $ € ; 0D '( ?$ > *K "O$ 6 = 1 Rh L C -N $ ! 0 $ ! 1 ,*+ W 2 k ! =@ ! ' 6 N "W ?$ „ P& " + 2 ! 1 d Y?$! , F ! !0 $ 6 " N ?$ S $ G 9 ! 0,-. ! ! ! ' M J = 1 )? ! Substance A B AB ! F I !J ! ! ! :; = $1 =@ ! S C "O$ 6 ' o 8 0 V &U /B +! "! " ! . B#, B ! ;; 1" N# O * & L; M# $ 8K 2 + 765 *#, & + REACTION Whole Blood AFFP Vasovagal Occasional Rare Hypovolemia Occasional Rare Allergic Very rare Very rare Citrate effect None Rare toxicity None Very rare 11 - Intrauterine transfusion
  46. 46. & P1 #Q ! "! $ ^ '6 !JD! ' N +! "! ! "! ! 1 $ d -Z $ "I +! '!J =@ ! % + ' 6 ! "! ! ? + , ! AFFPb apheresis fresh frozen plasma; Occasional: 0.5% to 2.5%; Rare: <0.5 %; very rare: <0.10%; Frequent: 5% to 20% ' ?* D @ ! ?3 , ! A ! ' N +! "! d -Z $ "I +! S E =@ ! ? + , ! $ A N! ! I +! S E A ?K! 0 $ 1 + " +! "! * B " +! "! % ^ } " ' 6 OVK I" + ! ? +t& k . 1 x 6 ' 6 -+ OVK t4 ! =@ ! ? + % + ' 6 " +! "! = 1 '! &D C J2 D "A -9 $7 H ? @ ! OVK @ ! % + ' 6 ! "! 0% + ' 6 ! "! * B W V$! C K +! "! @K! ? ! $4 . t ?&*$ ' t $ ‚ = " ! N V ' + s D! : D E F x 6 !JD! =^ #0f 1 ' K$ W " ' N +! "! C L FC A! ? =^ 1 $ % + ' 6 ' N +! "! ! I W " $! ! '!J C ? =@ ! $ * ! "A -9 @ @&*$ n ( "I +! B;$! L s '! F + @ ! 7! ? B;$! L s 7! ‚! ˆ & ! ?$! „L F s $ E ' $! N ' D O" ' ! 3Y 1 )? ! ' ! x 6 O?* D 7! ? ! 1$ O F A ?K! = 1 ' 6 ' D ! 0 +! "! $ 6 !JD! =@ ! ?3 0 ? + ' ! +! "! > *K! ' 1 0JNJN _ > *K! 0' " *K 7! ? † )6 I +! I" + $ s " ' 3$ 0 ?* $ +'! 2$ 7 H $^ 2? N "I +! = ?*" 7! ? @ * DO F ! 23 ! 0 W V$! @F ^> $ ? ‰! )? ! 0S 0' %+ _ 0 $ :F Š ! + 7! ? @ * ! 1$ 1 ' $! N @F I" + $ D ! * B $ $ * A &$ ' + W N O *-+ 0 +! 6 " ! ?$ J V = $ ! +! "! 7! ? K 7& + H -+ Z O *-+ K "A -9 J V = + n + O F I" + O" +! "! R ! B 1 1 $4 . 3 ; k Z "I +! + ! 2 0 1 $ ? 1 J V B E gp R . 2?*" 7 8 z R O *-+ 7 $ + -N =^ f0 e^ $ M J 2?*" $ME @ U ! O *-+ 7 $ + -N @ !
  47. 47. ! *$! $ A U $ U @-F n ! 3 " t & B 0S E 7 H " 7 $ J " = $! 1 1 $ RBC K " &*$ % + b@ ! * 0 %-F 0, ? ' x 6 C $4 . ' 96 $4 . 7 ! '6 ! 4 ' D $9 d O+ %H! ! "! 9 R =W ! ' D "C 1 ! )? ! 7 H ! $93 ! )? ! + " @ ! CU ‹ ' ! 1 $ , '! F &+ & 0 "! Y$ % + ' 6 ! "! ! I 0 $ ! $ ! n + " 2? ! 0C B F d 8F! , " Œ t $ -D d 8F! ", =@ ! $ ! ! ?U[ + $ ! )? ! ( U @ 3 = 1 $ JN " t & B ^ A ! # ' ! 1 x 6 ' 6 OVK =+ "! 6 n + 7 U3 C ! I" + 0 ? % =@ ! ? I" + 8Y3 Z D % ! )? ! t& k @ ! ?3 , ! ECBV0 + + d ? ' D + "C 1 T E = + $ V ! -U3 0A ).! $ W V$! ! JD W V$! C K +! 6 7 ; ! )? ! ^ ! 6 @3 " +! "! N ! E @ ;L = " I" + ! 7 U3 0 ! %H K " WBC ! ; D @-F W V$! „ ! "A C ! 6! = %:; n ! „ K C? @ ! "@ ) I" + " +! "! ?K 0 " WBC ! ; I" + " J+ %U3 =^ g@ ! 1 P) W V$! + %H! ! I ?F B;$! " ?+ "C -N $ ! @1! " $! 2$ ?1lN ! + $ N +! "! 7 $4 . " + @1! D $ J2 D =@ ! &$ < ! s + ƒ 0 $! ?1! ! "! 12 - ECBV Extra Corporeal Blood Volume
  48. 48. %D ; 1. Gilcher RO. Apheresis: Principles and thechnology of hemapheresis. In Simon TL, Dzick WH, Snyder EL, et al. (eds). Rossi's Principles of Transfusion Medicine. 3rd ed. Lippincott Wiliams & Wilkins, 2002:649-657. 2. Randles MJ. Selection and care of apheresis donors. In McLeod BC, Price TH, Weinstein R, eds. Apheresis: Principles & practice. 2nd ed. Bethesda, MD: AABB press, 2003:131-142. 3. Stands committee of the AABB: In Menitove JE(ed): Standards for Blood bank and transfusion services, 18th ed. Bethesda, MD, American Association of blood banks, 1999. 4. Winters JL, Pineda AA. Hemapheresis. In Henry JB(ed): Clinical Diagnosis & Management by laboratory Methods. 20th ed. WB Saunders, 2001:776-805. 5. Smith Jw. Automated donations: plasma, red cells, and multicomponent donor procedures. In McLeod BC, Price TH, Weinstein R, eds. Apheresis: Principles & practice. 2nd ed. Bethesda, MD: AABB press, 2003:147. 6. Gilcher RO. Novel hemapheresis donations. In Capon SM, Jeffries L, Mc Leod BC, eds. Selected topics in hemapheresis. Bethesda.MD: American Association of Blood Banks, 1996 7. Heddle NM, Klama L, Singer J, et al. The role of the plasma from platelet concentrates in transfusion reaction. N Eng J Med. 1994, 331: 625-628. 8. Brand A. Passenger leukocytes, cytokines, and transfusion reactions (editorial). N Eng J Med. 1994, 331: 670-671. 9. Smith Jw, Gilcher RO. Red blood cells, plasma, & other new apheresis drived blood products: Improving product quality & donor utilization. Transfus Med Rev. 1999, 13: 118-123.
  49. 49. 10. Owens MR, Sweeney JD, Tahhan RH, et al. Influence of type of exchange fluid on survival in therapeutic apheresis for TTP. J. clin. Apheresis. 1995, 10: 178-182. = U1J ' 6 A B?$! A H! =x K! 0W Y? ! 0W 2 " b = = [ ZF =jeipiqj 9)H =W -D ='! ! ' 6 A B?$! ' 12. McLeod BC, Price TH, Owen H, et al. Frequency of immediate adverse effects associated with apheresis donation. Transfusion. 1998, 38: 938 13. Hester JP, McCullough J, Mishler JM, et al. Dosage requirements for citrate anticoagulants. J. clin. Apheresis. 1983, 1: 149-175 14. Oslon PR, Cox C, McCoullough J. Laboratory and clinical effects of the infusion of ACD solution during plateletpheresis. Vox Sanguinis. 1987, 33: 79-87 15. Strauss RG. Effects on donors of repeated leukocyte losses during plateletpheresis. J. Clin. Apheresis. 1994, 9: 130-134.
  50. 50. Therapeutic PlasmaPheresis TPE Therapeutic Plasma Exchang ! ! TPE "# $ % & # ' (& )*+ ',$ - ./ $ 0 1 2+ 34 & 5 ! 6 7 ' & > 3 #? " 89 # #:;< 0& * = > - ! @ ! 6 7 - ./ $ 0 5 *; "& ,8 !" # $ %& # '() * + , I2+ 5 *; % " : CDHF G & & CDEF AB ; " & UC S TR Rh P Q+ BI 7 J & '?#K GL! M & - 8N O # @ ! ;?#K L B # 34 & UV WRUSLERC % ;Q ; P " 89 " 7 ] #K ^ L &# % $& & 0X ;7 - Y Z 8B [#; $& @' 5 5 - cd+ 3 _( & 8 , ; " L & ` a "b ; ?% Z 9 @' 5 ! "7 e ! B5 6&#7 Z $ 8 J#? TPE ;!dK #/ 8N #B ' ;? 0 # f e & "&#a Z & ' & $ h 7 % 8L % " 8 TPE `a & &@ $& e ! Z g+ ;9 @' 5 ! + # X L "& '! # ',$ 8 " 6 7 "7 # 9 " 7 ] #K K. , L # $^ i Me #j M e "& 0 # 9 " N & J ' #;, .;8 '9# ^ + - 9 & X ; Q ". 0 > d 8 ^ a&#9 6 7 & G7 g? - ' X L @ ! 8 n G a # &5 !5 & Il8 ^ m TPE k '! # p ! o#e # M 0X U TPE R 8 J#? r' $ "b G 9 J q C r ! ;! m :7 N TPE k '! # G a "b Z q S r' 8 n G a '! # J JqT 1 - Systemic Lupus Erythematosus
  51. 51. r' /N TPE 5 ! '! # Mm G 9 L " 89 B Ig 1 g 0 m :7 q V r !6 7 " . N TPE 8 J#? M+# #B q W r ! Y 2 Mm ? N TPE 8 J#? q E r' M+# 8N G ! TPE 5 & % q H r 8 & L TPE 8 ./ $ 0 1 qs r' ". N & (Z 1 NqD r' B / J B # N TPE 8 J#? qCF r ! Y2 Q N g+ & U " 7 % "; R M> N TPE q CC -. # / 0 "1 2 3 4 & U% ;Q ; P R SLE Gt B " #K L J " 7 ] #K ^ L &# % $& & 0 m :7 - [#; $& Rh P Q+ BI 7 & ' 5 5 - cd+ 3 8 , ; " L & ` a "b ; ? % " 89 o#e e & "&#a "7 e ! B5 6&#7 #l " B G L #l - " @'Q ! B ;J G ! ] #K B^ L &# `a & e ! B5 - A B- Q & M % B5# 2 B- MK # 8 B3LM4 % b ! 1 - '! # `a & TPE Mm ga @ ! @@@& ^&#;QM & + B- u &# 4 @ PL & v J &# B 5 $ & 5 ! # K M$ " #; v J , J nB G R ^ M& L I;Q ?( G > # K M$ " "J Z ? #/ " ' ',$ ; *8 , M % #> U" 7 " #$ G7 B- Q '! # ' " 7 " #$ ! #K n .? #e7 "& 2+ # O . "L & ; Q Q ; @ 5 ! S ' -L O . "J 'Q J ' I, TTP " 5w ' x. - #7J @ ! #j 8 # K M$ ; ` 2 ;? nB ;? ' ; ? "# $ G I Q 5&#K 8N 8;QB $ $ "b G 9 pUER ! 2 - Thrombotic Thrombocytopenic Purpura
  52. 52. & ; J 38$ B GL " : ' m 7 'M9 B^ L qC T GBM ( ;J 3 & #K 8; $ B ; J 8 @ 8;QB ;J @VIII ; ? B5 88 , & TTP % 4 ' L & SLE 8 88 GL 2 " 7 2 ; & L . ? B Kw & B^ L qS W V B3L4 0 : 5w ; J 38$ vM # " ! G+ Y 9 & " 7 'lM n .? 8 MK&# & Y M G4 ; ; LQ &#4 B Y 8 , L - A @ 8;QB 8 @ $& Y#;! " & E I &#;QM #4 B LDL 8 8! k # 8 I;Q #g , L qT - Q cd+ y&# " ? t ! B- u &# & UAmanita phalloidesR TPE # - @ . $ "b G 9 cd+ 0& *; # % TPE H I2+ #K 2 "& & - ./ $ 0 O# 5 ! cd+ ; ? " # - ./ $ l8 o (& 8B ; @ ! 5 *; " " TPE 8$ - TTP @' $ "b G 9 % 6&#7 ! TTP " TPE ' t #j ' 5 h< #B & ' $ "J ; ` 2 Z 88 , ; ? 8 ./ $ @UHR' - & 3 - Glomerul Basement Membrane Antibody 4 - Hyperviscosity 5 - Cold Insolubility 6 - Low Density Lipoprotein 7 - Volume overload
  53. 53. Table 8-Indications for Therapeutic Apheresis Generally Accepted for Reimbursement by Third-Party Payers 5 Plasma exchange IgG Myasthenia gravis Eaton-Lambert syndrome Goodpasture syndrome Myeloma with renal failure Guillain-Barre syndrome Hemophilia with factor VIII inhibitor Chronic inflammatory demyelinating polyradiculopathy IgM waldenström's macroglobulinemia Cryoglobulinemia Hyperviscosity Immune complex Glomerulonephritis, rapidly progressive Rheumatoid vasculitis Metabolic diseases Refsum's diseases Hyperlipoproteinemia, familial Cholestasis- intractable pruritus Diseases of unknown cause Thrombotic thrombocytopenic Thyroid storm Scleroderma, refractory Polymyositis, refractory Cytapheresis Acute leukemia-debulking Hairy cell leukemia-maintenance Thrombocytosis, symptomatic Chronic myelogenous leukemia, acute symptoms Red cell exchange Sickle cell disease Ig, immunoglobulin.
  54. 54. - ,8 0 +&8# : ;< += , 0 TPE 7 .8# 0 20 9 "1 6 TPE k "J '! # ! # 0 m :7 $ "b G 9 m p ! ;! 8 jJ "J L " &R ! ^ L &# + &z. ? + ! '! # 5 qC " #;M ? B # l h 7 #" B% 8L J e U ! CWFFF n @ ! '! # G a High Flux . B - 8N " 6 7 '! # e ! X ;Q # 9A 5 ! '! # Z qS IgG ^ t # @ ! U IQ ; R , J " G7 Q # Q #`# Q 5 3 $ ;J {a & B # " 0 m ;+ 5 & SC # # 9 "J # ` # cd+ ',$ - # 8 @ 8 nB | WF k ? & SC '!dK s GBM ; J t #K 5 *; TPE ! i Q> "b G 9 % IgG ;J @UDR ! TPE Y 2 & 'Q . $ } #/ #~ K a&#9 G7 'lM n .? @ ! ;! .;8 '9# #l Z qT @ /;Q , J .;8 '9# cd+ 3 8;QB 5 "J 'lM "b G 9 'lM & # TPE , #j @ ! a&#9 G7 "b G 9 qV N #B e /;Q n< & - - ^ " . & a&#9 G7 Bn< % #B #; TPE #j ! #; n< & - ^ " . & #; a&#9 6 7 & G7 n< m @ B 7 "J ` # cd+ e ! , Y& & a & 5 ! '! # Z qW ! • 9 &# ^ ;+ & 8 .B & 'a& c#m $ TPE k M 6 7` @UCFR ! &#( - . # ) 0> 20 9 .8# 0 # 4 Y2 0 + I;Q % 8 J#? Y 2 Ae & TPE '! # J % -& ^ t " 89 @ ! 0& *; " Q " k> 6 7 B 8 J#? -+G # ! | CFF # J a CF - & #; W G Ae " Q " TPE J & '9# L + 'Q ' ? ^ + - & - # @ ! ; G+ # Y 2 - + " 7 G # " #$ & vMa € #LM 9 )*+ - @ ! " 6 7 " 7 I2+ G LN n< ,8 l> #B 8 i2 B 8 - Glomerul Basement Membrane

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