Undergraduate Lecture

1. Apheresis

2. Overview
• Derives from Greek, “to carry away”
• A technique in which whole blood is
taken and separated extracorporealy,
separating the portion desired from the
remaining blood.
• This allows the desired portion (e.g.,
plasma) to be removed and the reminder
returned.

3. Definition
• Apheresis “a taking away” is a medical
technology in which the blood of a donor or
patient is passed through an apparatus that
separates out one particular constituent and
returns the remainder to the circulation.

5. Principle of Operation
• Blood reaching equilibrium after application of
centrifugal force:
Plasma (1.025-1.029 specific gravity)
Platelet (1.040)
Mononuclear (lymph, mono, PBSC,blast)
(1.070)
Granulocyte (neut, baso, eos) (1.087)
Neocyte RBC
RBC (1.093-1.096)

6. Principle of Operation
• Intermittent flow
– Blood processed in discrete batches
• complete a cycle before beginning the next one
•Needs to empty before next batch
• Continuous flow
– All fractions can be removed in ongoing manner

9. Anticoagulant
• Citrate
• Chelates calcium and block calcium
dependent clotting factor reactions
– Ensures extracorporeal blood remains in
fluid state
– Minimize activation of platelets and
clotting factors

10. 1. Centrifugation (specific gravity)
a) Intermittent flow IFC
b) Contineous flow CFc
2. Immunoadsorption
Apheresis by membrane filteration
3. Photopheresis
the separation of lymphocytes by apheresis, and
treatment of the cells with ultraviolet radiation.
Methods

12. Applications

13. Component collections
- Plateletpheresis
- Leucopheresis
- Erythrocytapheresis
- Plasmapheresis
- Stem cell collection

15. Therapeutic Procedure
-Therapeutic cytapheresis
-Therapeutic plasma exchange
1) Paraproteins (Waldenstorm’s Macroglobulinem
2) Autoantibodies
3) Lipids (LDL in familial hypercholesterolemia;
4) Toxins or drugs (that are bound to albumin)
5) Circulating immune complexes (CIC)

16. Therapeutic Cytapheresis
1. Plateletpheresis the platelet count can be decreased
by 60% of the initial value.
2. Leucopheresis : e.g leukemia
3. Lymphocytespheresis .
4. Erythrocytapheresis : e.g SCA, severe parasitemia
5. Stem cells harvesting, Donor or patient.

17. Therapeutic Plasmapheresis
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

18. Drug Removal
• Can remove:
– tobramycin,vancomycin, propranolol
• May reduce plasma levels of enzymes that
metabolize drugs
• May reduce plasma levels of proteins that bind
and transport drugs

19. Donation Criteria
 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 transmitted diseases 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.

20. Donation Interval
 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.

21. Total blood volume according to
body mass/ml rate
Newborn82-86 ml/kg
Premature89-105 ml/kg
Infant73-82 ml/kg
70ml/kg Adult
Extracorporeal volume (ECV) and TBV
ECV not more than 15% of TBV

22. Evidence based Guidelines For
Therapeutic Apheresis
By American Society for Apheresis ASFA
Category I:
 Considered primary or standard therapy
usually on basis of controlled trials
Category II:
 Supportive or adjunctive to other therapy

23. Evidence based Guidelines For Therapeutic
Apheresis
Category III:
 Insufficient data to determine effectiveness;
results of clinical trials may be conflicting or
uncontroled anecdotal reports of efficacy
Category IV:
 do not respond to apheresis therapy

24. Guidelines for Therapeutic Cytapheresis
Leukemia with hyperleukocytosis
syndrome
Sickle cell syndrome
Thrombocytosis
Cutaneous T-cell
lymphoma
Hairy cell leukemia
Hyperparasitemia (e.g.,
malaria)
Peripheral blood stem cell
collections for
Hematopoitic reconstitution
Category I Category II

25. Life-threatening hemolytic
Transfusion reactions
Multiple sclerosisSickle cell
disease
Leukemia without hyperleukocytosis
syndromes
Hypereosinophilia
Category IVCategory III

26. Guidelines for Therapeutic Plasmapheresis
Category I Category II
Thrombotic Thrombocytopenic Purpra
(TTP).
Coagulation factor inhibitors
Homozygous familial
hypercholesterolemia
Hyperviscosity syndrome
Postransfusion purpura
Rapidly progressive
glomerulonephritis
Chronic inflammatory demyelinating
polyneuropathy
Cold agglutinin
Drug overdose and poisoning
(protein-bound toxins)
HUS

27. AIDS (for symptoms of
immunodeficiency)
Aplastic anemia
Rheumatoid arthritis
ABO-incompatible organ or marrow
transplantation
Maternal treatment of Maternal-fetal
incompatibility (HDN)
Transfusion refractorines due to
Alloantibodies (RBC, platelet, HLA)
Warm autoimmune hemolytic anemia
Category III Category IV

28. Adverse Effects of Apheresis
1- Citrate toxicity
2- Vascular complications
hematoma, sepsis, phlebitis, neuropathy.
3- Hypervolemia.
4- Allergic reaction.
5- Haemolysis.
6 -Air embolus.

29. 7- Depletion of clotting factors.
8- Circulatory and respiratory distress.
9- transfusion transmitted diseases.
10- loss of lymphocytes.
11- depletion of proteins and immunoglobulin

30. Fluid replacement during apheresis
• When an apheresis system is used for
therapy, the system is removing
relatively small amounts of fluid (not
more than 10.5 mL/kg body weight).
• That fluid must be replaced to keep
correct intravascular volume

31. Conclusion
 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.

32. Thanks