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Technique in which whole blood is withdrawn –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
5.
6.
7. DonationCriteria
7
• 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
8
•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
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
1
11. DISADVANTAGES
1
The amount of components harvested is less than the
automated machines.
Time consuming.
Volume of blood taken out from the body ismore.
12. APHERESISMACHINES
1
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
14. Apheresis- Mechanism of Action
14
•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.
16
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.
19
21. PLATELETPHERESIS
21
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
22
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.
23
24. NEOCYTAPHERESIS
24
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
25
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
26
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
28. APPLICATIONOF PLASMAPHERESIS
28
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
31. THERAPEUTICLEUKAPHERESIS
31
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
32
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
35
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
