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APHERESIS [Autosaved].pptx apheresis ppt for mlt

Apheresis is a medical procedure that involves withdrawing blood from a donor or patient, separating its components for specific harvesting, and returning the remaining blood. Various types of apheresis include plasmapheresis, cytapheresis, plateletpheresis, leukapheresis, and erythrocytapheresis, each with specific criteria for donor selection and procedural requirements. The process is governed by strict regulations concerning donor health, screening for infectious diseases, and equipment maintenance.

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APHERESIS I.ABDUL AZEES MSC MLT Pathology
• Apheresis (or hemapheresis) is a Greek word that means to separate or remove. In apheresis blood is withdrawn from a donor or patient in anticoagulant solution and separated into components. One (or more) component is retained and the remaining constituents are returned to the individual. Any one of the components of blood can be removed and the procedures are specified for the component selected. • Apheresis is a procedure carried out to harvest a particular component and returning the rest of the blood to the donor by an automated machine. This procedure shall be carried out only in a Blood Centre licensed for this purpose
• At least 48 hours must elapse between successive apheresis and not more than twice in a week. For hematopoietic stem cells, the procedure can be done daily. oProcess of removing Plasma- Plateletpheresis oProcess of removing platelets- Leukapheresis oProcess of removing Red cells- Erythrocytapheresis AUTOMATED CELL-SEPARATOR MACHINES - used for both component preparation and therapeutic applications. MANUAL APHERESIS-whole blood is collected in multiple bags system and centrifuged off-line. It involves great care that the bags are labeled correctly and their contents are returned to the correct donor. With the current available automatic technology now the manual process is seldom used.
GENERAL REQUIREMENTS FOR APHERESIS Equipment's should be good and in proper condition Qualified and licensed Physician Well trained Technicians SOP and Troubleshooting manual The apheresis operator must be patient-friendly Records of lab findings should be kept
GENERAL CRITERIA FOR SELECTING APHERESIS-DONOR Donors should be repeat donor Written consent must be obtained from the donor about the procedure details and hazards Venous accesses must be done during selection of donor Donors should be screened for Infectious diseases • Age - 18-50 years. • Weight ->60 Kg. • Hemoglobin - >12.5 g/dl Tests for hemoglobin, ABO group, Rh type, and screening for unexpected antibodies are done.
TYPES OF APHERESIS PROCEDURES AND THEIR APPLICATION
PRINCIPLE OF OPERATION: • The separation of blood components is based on the specific gravity or weight of each individual blood constituent. • Apheresis technology utilizes this same principle for separating blood components.
PRINCIPLE OF APHERESIS: • Blood is removed from an individual (Usually with a large – bore needle) • Mixed with anticoagulant and transported directly to the separation device (typically a machine with a centrifuge bowl or belt) • There it is separated into specific components. • Once withdrawn, the remaining portions of the blood are then mixed and returned to the donor or patient.
PHYSIOLOGY OF APHERESIS • Apheresis collection of a blood component, whether for therapeutic or nontherapeutic purposes, is obviously different from the routine collection of a unit of whole blood. • Anticoagulant • Fluid shift • Cell loss
ANTICOAGULANT • Citrate is used as the primary anticoagulant in apheresis procedures • The binding of calcium ions by citrate inhibits the calcium-dependent coagulation cascade • If calcium ions are not available, coagulation cannot proceed to its normal end-point.
CELL LOSS • For both donor and patient apheresis procedures the goal is to intentionally remove a specific cellular component. This would be expected to decrease circulating levels of the specific cells however, other cellular components may be affected as well. FLUID SHIFTS • During an apheresis procedure, changes in intravascular volume occur secondary to removal of blood into the extracorporeal circuit. During donor apheresis procedures, the total volume of components collected may be more than the simple whole blood donation. If additional fluid is not infused during the apheresis procedure, the donor may experience hypotension due to the depletion of intravascular volume.
METHODS OF CENTRIFUGATION: 1. Intermittent flow centrifugation (IFC) 2. Continuous flow centrifugation (CFC).
INTERMITTENT FLOW CENTRIFUGATION In an IFC procedure, blood is processed in batches or cycles, hence the term intermittent. Require the use of a disposable unit consist of sterile tubings and a bowl. Blood is drawn from an individual mixed with the anticoagulant with the help of a pump and pumped into a centrifuge bowl through the inlet port. The blood gets separated in the bowl into various components by differential centrifugation. The separated components flow from the bowl through the outlet port, with the desired components being harvested into a separate collection bag. The centrifuge stops and the pump gets reversed. It completes one cycle
The Haemonetics MCS Plus LN9000
CONTINUOUS FLOW CENTRIFUGATION (CFC). • In a continuous flow centrifugation (CFC) procedure, the processes of blood withdrawal, processing, and reinfusion are performed simultaneously in an ongoing manner. This is in contrast to IFC procedures, which complete a cycle before beginning the next one. Because blood is drawn and returned continuously during a procedure, two venipuncture sites are necessary. Blood is withdrawn from an individual with the assistance of a pump mixed with an anticoagulant. Blood is collected in a chamber or belt. Separation of a components is achieved through Centrifugation. Desired components is diverted into a collection bag and remaining is reinfused.
THERAPEUTIC PHLEBOTOMY USING CFC: • Alternatively, especially with therapeutic procedures, a dual-lumen central venous catheter can be used. • Blood is drawn from the phlebotomy site with the assistance of a pump, mixed with anticoagulant, and collected in a specially designed chamber or belt, depending on the instrument. • Separation of the components is performed by centrifugation, and the specific component is diverted and retained in a collection bag. • The remainder of the blood is reinfused to the individual via the second venipuncture site.
Baxter/Fenwal CS-3000 Plus CaridianBCT COBE Spectra The separation chamber uses a unique asymmetric design to minimize contamination from RBCs and WBCs-CaridianBCT COBE Spectra
Over the last several years, improvements in apheresis tech nology have allowed IFC and CFC processes to be incorpo rated into a single platform. Examples of this platform are the Trima from CaridianBCT. The Trima Accel Automated Collection System.
MEMBRANE FILTRATION: • Membrane filtration technology can also be used to separate blood components. • Membrane separators are typically composed of bundles of hollow fibers or flat plate membranes with specific pore sizes. • As whole blood flows over the fibers or membrane, plasma passes through the pores and is collected, while the remainder of the cellular components is returned to the donor. • This technology lends itself well to the collection of plasma since pores can be sized to prevent the passage of even small cellular elements. • Filtration has several advantages over centrifugation, including the collection of a cell-free product and the ability to selectively remove specific plasma proteins by varying the pore size. • The Fenwal Autopheresis-C instrument combines centrifugation and membrane filtration technology through the use of a small rotating cylindrical filter. Like other filtration technology, it is used only for plasma collection.
TYPES OF APHERESIS: 1) Plasmapheresis 2) Cytapheresis
PLASMAPHERESIS: It is a procedure to harvest plasma from whole blood and returning the cellular components to the donor. Plasma is harvested by an automated machine. • Selection of donors For selection of plasmapheresis donor, the donor shall fulfill all the crieteria as per regulatory guidelines. The total serum protein shall be more than 6 gm/dl before the first plasmapheresis procedure. It should be tested before the third procedure if done within four weeks, and it shall be ≥ 6 gm/dl. In repeated plasmapheresis in which plasma is donated more frequently than once every 12 weeks, the donor should be tested before every pheresis procedure. Haemoglobin should be ≥ 12.5 g/dl and/or Hct ≥ 38%
In repeated plasmapheresis programme with the return of the cellular components a minimum interval shall be of 48 hours between two procedures (not more than 2 times a week, limited to 24 in one year). Volume of plasma: Volume of plasma obtained excluding anticoagulants from a donor weighing at least 55 kg shall not exceed 500 ml with serum protein within normal limit during one procedure or not more than 1000 ml per month with a maximum of 12 L / year. Extra corporeal blood volume should not exceed 15% of the donor’s estimated blood volume. Records: Records of donor’s periodic examination, laboratory tests, consent of donor/patient, date of last apheresis procedure, certificate of the attending physician, procedure details, volume of product separated, drugs used, adverse reaction if any and their treatment shall be maintained
CYTAPHERESIS Cytapheresis is the procedure for the separation of individual cellular components of blood. It can be achieved by the cell separator machine, using a continuous or intermittent cell separator. It includes 1) Plateletpheresis 2) Leucapheresis for harvesting a. Granulocyte concentrate b. Lymphocytes c. Mononuclear cells 3) Erythrocytapheresis 4) Haematopoietic stem cells (peripheral blood stem cells): Attempt should be made for harvesting a minimum of 2x10 6 CsD34 cells and/or minimum of 2x108 MNCS/Kg of the recipient.
• Selection of donors: Donors who do not meet allogeneic donor requirements shall undergo apheresis only when the components are expected to be of particular value to an intended recipient and only when approved by the medical director. • The interval between procedures for platelet, erythrocyte, and leucocyte donors shall be as per regulatory requirements.A donor (except for erythrocytes) shall undergo the procedure a maximum of two times in 7 days period or not more than 24 times in a year. • In case of blood donors who undergo cytapheresis no more than once every 4 weeks should be treated as ordinary blood donors and routine donor screening with laboratory tests should be done.
PLATELETPHERESIS • The term plateletpheresis includes platelets collected by apheresis using a cell separator, and the product is called single donor platelets and includes washed single donor platelets, modified single donor platelets (with replacement of compatible plasma), leuko-reduced single donor platelets and double (single donor) platelets collected from single donor Donor selection: • Platelet-pheresis shall not be carried out on donors who have taken medication containing aspirin or similar medicines within 3 days prior to donation. • Donors with a personal and family history of bleeding tendency are not suitable forplateletpheresis. • Platelet count should be determined before plateletpheresis and should not be below 150,000 / ul. Plateletpheresis donors with a platelet count of less than 1,50,000/ul shall be deferred from platelet donation until a subsequent platelet count is at least 1,50,000/ul.
Storage • Shall be kept up to 5 days between 20o C to 24o C with continuous agitation. Quality Control i) Apheresis platelet concentrate should contain a minimum of 3 X 10 11 platelets/unit in 75% of the units tested amongst 1% of monthly production or 4 platelet concentrates per month, whichever is higher. ii) pH must be 6 or higher at the end of the permissible storage period. iii) To be considered leucocyte reduced, platelets must contain less than 5x106 leucocytes per unit. iv) Minimum SDP volume shall be 200 ml in order to maintain optimum pH of platelets. v) If a blood centre uses PAS as additive solution volumes may change, however, the shelf-life shall still be limited to 5 days or in accordance with regulatory requirements.
LEUCAPHERESIS • This procedure includes a collection of granulocytes (granulocytapheresis),lymphocytes or peripheral blood stem cells or haematopoietic stem cells for the treatment of traditional conditions followed by their preservation. • Before leucapheresis total white blood cells counts should be ≥ 4000 /ul with the normal differential count. • Donors may receive drugs to facilitate leucapheresis. Such drugs should not be used for donors whose medical history is suggestive of some disease. • Leucocyte concentrate should contain at least 1 x 1010 leucocytes.
• Granulocyte concentrates shall be stored at 200 to 240 C for 24 hours without agitation. • The red cells in the concentrates should be ABO compatible with the recipient’s plasma. The component should be cross-matched if >2ml of red cells are present. • These should be transfused as soon as possible, preferably within 6 hrs. • Transfusion should not be given through micro aggregate filters because it will remove the collected granulocytes. • Irradiation is required to prevent GvHD.
ERYTHROPHERESIS This is the collection of two units of red cells from a single donor meeting specified requirements The donor should have haemoglobin ≥ 13.5g /dl and weigh more than 65 Kgs