Apheresis is a technique where whole blood is collected from a donor or patient and separated into its components. The desired component is retained while the remaining constituents are returned. It is used to collect blood components for transfusion or remove pathological components. There are two main types of apheresis machines - intermittent flow centrifugation and continuous flow centrifugation. The process involves drawing blood, separating components via centrifugation, and collecting the desired component while returning the rest. Complications can include citrate toxicity, allergic reactions, and hypotension. Apheresis provides benefits over regular blood donation such as less HLA sensitization and lower risk of transfusion-transmitted infections.

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APHERESIS

2. Apheresis is derived from a greek word meaning “to
take away”
Technique in which whole blood is withdrawn –
separated into its components – desired component is
retained and remaining constituents are returned to
donor
DEFINITION

3. INDICATIONSOF HAEMAPHERESIS
3
To collect the components for transfusion
purposes
Platelets
Leucocyte
s
- Plateletpheresis
- Leucapheresis
Plasma - Plasmapheresis
Peripheral blood stem cells
Toremove pathological component
Therapeutic Apheresis

4. MECHANISAM OF ACTION
Large-bore intravenous catheter is connected to spinning
centrifuge bowl
Whole blood collected from donor/ patient into the
centrifuge bowl
More dense elements like RBCs settle to the bottom –
then WBC – Platelets – and plasma on the top

7. DonationCriteria
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• Donors for apheresis procedure must meet the criteria
applicable as the donors for normal donation.
ABO and Rh typing,
Testing for transfusion transmitted diseases
Antibody screening
• A drug history should be obtained; donors who have
taken aspirin or aspirin containing medications within
3 days of donation should be temporarly deffered.

8. DonationInterval
donor &patient
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•The interval between platelet donations should be at least
72 hours, with no more than two donations in a week,4
times in a month and 25 donations in a year.
•Platelet count should be more than 1.5 lakhs
•Plasmapheresis donors may donate as often as every 48
hours but not more than twice in a 7-day period.
•Serum protein concentration should be more than 6 gm/dl.
•Written informed consent must be obtained from the

9. Methodology
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Manual Method
Apheresis Machines
1. Centrifugation (specific gravity)
a) Intermittent flow IFC
b) Continous flow CFC
2. Immunoadsorption
Apheresis by membrane filteration

10. MANUALMETHOD
Blood collected into plastic bag which containing
anticoagulant preservative solution
Bag centrifuged to get desired component, which is
separated into a satellite bag
Remainder is infused through the same vein.
Process is repeated
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11. DISADVANTAGES
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The amount of components harvested is less than the
automated machines.
Time consuming.
Volume of blood taken out from the body ismore.

12. APHERESISMACHINES
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The machines are broadly of two types
Intermittent flow centrifugation(IFC)
Haemonetic Model S-30,V-50,MCS Dideco
Progress
Continous flow centrifugation(CFC) Cobe
Spectra
Dideco Viva
Fresenuis

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14. Apheresis- Mechanism of Action
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•Large-bore intravenous catheter connected to a
spinning centrifuge bowl
•Whole blood is drawn from donor/patient into the
centrifuge bowl
•The more dense elements, namely the red cells, settle
to the bottom with less dense elements such as white
cells and platelets overlying the red cell layer and
finally, plasma at the very top.

15. INTERMITTENTFLOW CENTRIFUGATION
Require the use of a disposable unit consist of sterile
tubings and a bowl.
Blood is drawn from an individual and mixed with the
anticoagulant with the help of a pump and pumbed
into centrifuge bowl through inlet port
The blood gets separated in bowl into various
components by differential centrifugation.
15

16. •The separated components flow from the bowl through
outlet port, with the desired component being harvested
into a separate collection bag.
•The centrifuge stops and pump gets reversed
•This completes one cycle.
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17. Haemonetics centrifuge bowl.
IFC Procedure.
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18. ADVANTAGE
Single venous
access.
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DISADV
ANTAGE
Time taken is more.
Extracorporeal volume is more.

19. CONTINOUSFLOW CENTRIFUGATION
Blood is withdrawn from an individual with the
assistance of a pump, mixed with the anticoagulant
Blood is collected in a chamber/belt
Separation of the components is achieved through
centrifugation
Desired component is diverted into a collection bag and
remainder is reinfused into individual through second
venous access.
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20. ADVANTAGES
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Time required is less
Less extracorporeal volume
DISADV
ANTAGES
Two access required.

21. PLATELETPHERESIS
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Removal of platelet from donor and return of red cell,
white cell and plasma
The platelet concentrate prepared by cell seperator
should have minimum2.5x1011
Routine procedure takes 90 min-2 hours
Stored for 5 days on platelet agitator at 22 degrees.If it
is prepared in open system, It must be transfused with
in 24hr.
INDICATIONS
Thrombocytopenia
Aplastic Anemia
Bone marrow Transplant.

22. LEUCAPHERESIS
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Removal of leucocytes with return of red cells, platelets
and plasma.
Required for treating sepsis.
Granulocyte concentrate must contain minimum of
1x1010 granulocytes .
Shelf life is 24 hours.
Granulocyte collection yield by apheresis procedure
can be increased by
◦ Giving steroids
◦ Addition of red cell aggregating agents Eg.HES

23. CORTICOSTEROIDS
Corticosteroids are believed to increase the vascular pool of
granulocyte by stimulation of bone marrow to increase
cellular output to blood.
eg., Dexamethasone- Dose-6-12mg, prednisolone-40-60mg
Haematopoietic growth factor
G-CSF OR GM-CSF
 Hydroxyethylstarch
It is available as6% solution in0.9%saline and is
added to the input line of cell seperatorin the dose of 170-
500ml for 4-10 litter of blood.
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24. NEOCYTAPHERESIS
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PRINCIPLE OF SEPARATION
Young, larger and less dense red cells are
expressed earlier than older cells.
In patients requiring repeated transfusions
The administration of relative young cells will improve
management by
Decreasing frequency of transfusion Decrease the rate of
iron loading.
Expensive, time consuming.

25. PLASMAPHERESIS/PLASMAEXCHANGE
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It is the procedure in which the whole blood is
withdrawn from donor/patient, anticoagulated and
separated into components with return of separated
cellular components to donor/patient
If relatively small volume of plasma are removed and
replaced by saline, the term Plasmapheresis is used.
If more plasma is moved, it become necessary to infuse
plasma or plasma protein fraction to replace the lost
plasma proteins, this is called Plasma Exchange

26. INDICATIONSFOR PLASMAPHERESIS
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Removal of antibodies
◦ Allo antibodies
HDN
Anti Rh antibodies in pregnant women
Neonatal thrombocytopenia
◦ Auto antibodies
◦ Myasthenia gravis Acute polyneuritis
Removal of immune complexes
o SLE
o RA

27. Hyper viscosity syndrome
Multiple Myeloma
Waldenstorm’s Macroglobulinemia
Removal of toxins
Hepatic failure Renal failure
Replacement of deficient plasma component
TTP
HUS
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28. APPLICATIONOF PLASMAPHERESIS
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Plasmapheresis of normal donors for preparation of
plasma fraction
Therapeutic plasmapheresis- to remove some
particular constituent from patients plasma
REPLACEMENT FLUIDS FOR PLASMA
EXCHANGE
Crystalloid
Albumin
Plasma protein fraction (PPF)
FFP

30. COMPLICATIONSOFPLASMAEXCHANGE
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Reactions to replacement fluids
Vaso- Vagal reactions
Pyrogenic reactions
Hypothermia
Hypocalcemia
Thrombocytopenia
Anaemia
Hypogammaglobulinemia

31. THERAPEUTICLEUKAPHERESIS
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Has been tried in patients of CML, but general opinion
is that apheresis is ineffective probably due to rapid
production rate of cells in comparison to the number of
cells removed through apheresis.
Leukapheresis is most effective in
Chronic lymphosarcoma
Prolymphocytic leukemia
Hairy cell leukemia
Eosinophilic syndrome
Sezary cell syndrome

32. THERAPEUTIC THROMBOPHERESIS
Done in cases with essential thrombocythemia
RED CELL PHERESIS
Done in patients with sickle cell disease especially
during sickle cell crisis
Severe parasitic load
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ADV
ANT
AGESOF APHERESIS
Less HLAsensitization.
Less chances of TTD.
More effective than usual
component donation

33. PHOTOAPHERESIS
It is a form of apheresis in which blood is
treated with Photoactivable drugs which are then acttivated
with UV light.
• It is approved for cutaneous T cell lymphoma(CTCL)
•It is also affect in T –cell mediated disorder
eg:GVHD
Solid organ transplant rejection
PROCEDURE
• Perfomed through intravenous acees
•The process takes 3-4 hr to compleat the process
• 3 Basic stage
1.leukapheresis
2.Photoactivation
3.Reinfusion

34. • Peripheral intravenous line or central venous access is established in
patients
• Blood is passed through the different cycle of leukapheresis depend
on the patient hematocrite value and body size and at the end of the
each leukapheresis platelet and plasma is returned to the patient
• The collected WBCs( Peripheral blood mononuclear cells) are mixed
with
heparin, saline, and 8- methoxypsoralen(8-MOP),Which interacts into
the
DNA of the lymphocytes up on exposure to uv light and more
susceptible
to apoptosois.
• The treated WBC mixture is returned to the patient.

35. ADVERSE EFFECT OF APHERESIS
IN DONORS
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Citrate toxicity
Donor may feel numbness or tingling sensation
around the mouth.
Problem solved by
•Giving exogenous calcium
•Decreasing the rate of infusion of returned
component
Adverse effect of HES may occur Febrile allergic
rections:
Head ache,
Mild hypertension
Edema of extrimities

36. COMPLICATIONS
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Hypocalcemia
Air embolism
Hypo fibrinogenemia
Hypotension
Vaso vagal reactions
Haematoma, infection in the site of venous access
Allergic reactions

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