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1
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2- Leukopheresis
3
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4
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5
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16. '+2dF D R 2 F ? I1 3 a & ! R ; 1 2 & CD
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% !
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8 1 %$B" F ;, = 7 1 ^ 1 ( ? ! &' 7 F 2D 1 8 j>
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& CD L = = ! - 3 8 A9, K 7 , ' ) * :2F F + !
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8 A Latham G 4 ! ! + % ! ) 7 ! IZ k] R2 1 ['
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7
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8
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z )6 ! * h T=] ) G ! Y ( 7 92 + % ,1 3
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% & 1 n&
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' % ! 1 &2! N F ! 8 X )! 3 1 '^ 1 G R ! ! { ] Spectra
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2SF Latham x !| ! 9 ( Haemonetics K&
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7I = ' ;2 1 :2F F ! 1 * J ? 7 F :2F F + ! % , { O
1 R! * J ? 2X! & D 1 RBC Y ' % & 1 n&
1 SY 2 1 / - % P 1 ! )&? + 29>F RBC K % M3
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9
- Extracorporeal
20. (F (2 6F ( F %$@`` mL <" G ^1 $H`` mL <"
S ' 1 ! 1 &2! , ' 1 1| '(2 6F =
R! F < 1 7| ! Y 7 ! C? % & )6
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+ h * ! R f S 71 i m F 1 i, D V2 8 J 1 ! ' 2D
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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.
22.
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7
Idiopathic thrombocytopenic purpura
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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.
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6 e % # - IgG d < X l -+ E !, X 0 3 w h 6 % ' ,YN +
d 3 ' ? % % ,_* % 6 ' N X0 ![ ! N+ - D* A 0 [
32. % 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
33. 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
34. %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 !
35. *"-#")( 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
36. / 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
37. 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
38. 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:
39. 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
40. 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
41. !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
42. 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.
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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.
43. 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
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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.
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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.
44.
45.
46. %"#$ !
" ! "!
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
47. '! '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.
48. % &
= $ 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
49. ]+! 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
50. '! 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
51. 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
52. 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
53. % 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
54. & 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 @ !
55. ! *$! $ 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! , " Πt $ -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 $! ?1! ! "!
12
- ECBV Extra Corporeal Blood Volume
56. %D ;
1. Gilcher RO. Apheresis: Principles and thechnology of hemapheresis. In Simon
TL, Dzick WH, Snyder EL, et al. (eds). Rossi's Principles of Transfusion Medicine.
3rd ed. Lippincott Wiliams & Wilkins, 2002:649-657.
2. Randles MJ. Selection and care of apheresis donors. In McLeod BC, Price TH,
Weinstein R, eds. Apheresis: Principles & practice. 2nd ed. Bethesda, MD: AABB
press, 2003:131-142.
3. Stands committee of the AABB: In Menitove JE(ed): Standards for Blood bank
and transfusion services, 18th ed. Bethesda, MD, American Association of blood
banks, 1999.
4. Winters JL, Pineda AA. Hemapheresis. In Henry JB(ed): Clinical Diagnosis &
Management by laboratory Methods. 20th ed. WB Saunders, 2001:776-805.
5. Smith Jw. Automated donations: plasma, red cells, and multicomponent donor
procedures. In McLeod BC, Price TH, Weinstein R, eds. Apheresis: Principles &
practice. 2nd ed. Bethesda, MD: AABB press, 2003:147.
6. Gilcher RO. Novel hemapheresis donations. In Capon SM, Jeffries L, Mc Leod
BC, eds. Selected topics in hemapheresis. Bethesda.MD: American Association of
Blood Banks, 1996
7. Heddle NM, Klama L, Singer J, et al. The role of the plasma from platelet
concentrates in transfusion reaction. N Eng J Med. 1994, 331: 625-628.
8. Brand A. Passenger leukocytes, cytokines, and transfusion reactions (editorial). N
Eng J Med. 1994, 331: 670-671.
9. Smith Jw, Gilcher RO. Red blood cells, plasma, & other new apheresis drived
blood products: Improving product quality & donor utilization. Transfus Med Rev.
1999, 13: 118-123.
57. 10. Owens MR, Sweeney JD, Tahhan RH, et al. Influence of type of exchange fluid
on survival in therapeutic apheresis for TTP. J. clin. Apheresis. 1995, 10: 178-182.
= U1J ' 6 A B?$! 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.
58.
59.
60. 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 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	 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
61. 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 #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
62. & ; 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  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 ! 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
63. 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.
64. - ,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	 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	 G7 "b G 9 qV
N #B e /;Q n< & - - ^ " . & a	 G7 Bn< % #B
#; TPE #j ! #; n< & - ^ " . & #; a	 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
