1. APHERESIS
SUNIL KUMAR.P
Department of Clinical pathology
St.John’s Medical College
Bangalore
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
2. Derived from Greek, “to carry away”
•Hemapheresis is the removal of whole blood from
donor/patient, separation into components, retaining
the desired/unwanted component and return of
remaining constituents to the donor/patient.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
3. INDICATIONS OF HAEMAPHERESIS
To collect the components for transfusion
purposes
Platelets - Plateletpheresis
Leucocytes - Leucapheresis
Plasma - Plasmapheresis
Peripheral blood stem cells
To remove pathological component
Therapeutic Apheresis
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
4. Donation Criteria
Donors for apheresis procedure must meet the criteria
applicable as the donors for normal donation.
ABO and Rh typing,
Testing for transfusion and 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 temporarily deferred
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
5. Donation Interval
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
donor & patient
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
6. Methodology
Manual Method
Apheresis Machines
1. Centrifugation (specific gravity)
a) Intermittent flow IFC
b) Continous flow CFC
2. Immunoadsorption
Apheresis by membrane filteration
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
7. MANUAL METHOD
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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
8. DISADVANTAGES
The amount of components harvested is less than the
automated machines.
Time consuming.
Volume of blood taken out from the body is more.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
9. APHERESIS MACHINES
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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
10. SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
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11. SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
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12. Apheresis- Mechanism of Action
•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.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
13. INTERMITTENT FLOW 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.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
14. •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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
16. ADVANTAGE
Single venous access.
DISADVANTAGE
Time taken is more.
Extracorporeal volume is more.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
17. CONTINOUS FLOW 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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
18. ADVANTAGES
Time required is less
Less extracorporeal volume
DISADVANTAGES
Two access required.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
19. PLATELETPHERESIS
Removal of platelet from donor and return of red cell,
white cell and plasma
Routine procedure takes 90 min-2 hours
Stored for 5 days on platelet agitator at 22 degrees.
INDICATIONS
Thrombocytopenia
Aplastic Anemia
Bone marrow Transplant.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
20. LEUCAPHERESIS
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
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
21. CORTICOSTEROIDS
Corticosteroids are believed to increase the vascular
pool of granulocyte by stimulation o bone marrow to
increase cellular output to blood.
Eg., Dexamethasone, prednisolone
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
22. NEOCYTAPHERESIS
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.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
23. PLASMAPHERESIS/PLASMA EXCHANGE
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
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
24. INDICATIONS FOR PLASMAPHERESIS
Removal of antibodies
◦ Allo antibodies
HDN
Anti Rh antibodies in pregnant women
Neonatal thrombocytopenia
◦ Auto antibodies
Myasthenia gravis
Acute polyneuritis
Removal of immune complexes
SLE
RA
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
25. 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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
26. APPLICATION OF PLASMAPHERESIS
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
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
27. COMPLICATIONS OF PLASMA EXCHANGE
Reactions to replacement fluids
Vaso- Vagal reactions
Pyrogenic reactions
Hypothermia
Hypocalcemia
Thrombocytopenia
Anaemia
Hypogammaglobulinemia
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
28. THERAPEUTIC LEUKAPHERESIS
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 cell leukemia
Prolymphocytic leukemia
Hairy cell leukemia
Eosinophilic syndrome
Sezary cell syndrome
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
29. HAEMATOPOEITIC STEM
CELL
Two types
1. Autologous
2. Allogenic
Donor or patient treatment with growth factor to
mobilise peripheral blood stem cells
CD 34 cell count done on product to ensure good quality
product
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
30. 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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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
31. ADVANTAGES OF APHERESIS
Less HLA sensitization.
Less chances of TTD.
More effective than usual component donation.
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
32. ADVERSE EFFECT OF APHERESIS IN
DONORS
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
Oedema of extrimities
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
33. COMPLICATIONS
Hypocalcemia
Air embolism
Hypo fibrinogenemia
Hypotension
Vaso vagal reactions
Haematoma, infection in the site of venous access
Allergic reactions
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SUIL KUMAR P . ST.JOHN'S MEDICAL
COLLEGE , BANGALORE
