1. Plasmapheresis involves removing plasma from a patient and replacing it with either fresh frozen or stored plasma. It can remove pathogenic factors like antibodies, immune complexes, and proteins.
2. There are two main techniques for plasmapheresis - centrifugal separation and membrane plasmafiltration. Complications can include hypotension, bleeding, and allergic reactions.
3. Plasmapheresis is used to treat various conditions and is categorized based on evidence. It may be used as an adjunctive therapy for sepsis to remove harmful molecules.
A detailed discussion on a very much in demand topic. Covered all aspects of the procedure which are important for an Emergency, Medical and Intensive Care physician should know. Nurses can also benefit from the presentation as we have tried to keep it as simple and straight forward as possible.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
- English version of this lecture is available at:
https://youtu.be/V3UGzJTwAWw
- Arabic version of this lecture is available at:
https://youtu.be/hGLaUde2ue4
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
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A detailed discussion on a very much in demand topic. Covered all aspects of the procedure which are important for an Emergency, Medical and Intensive Care physician should know. Nurses can also benefit from the presentation as we have tried to keep it as simple and straight forward as possible.
A very simple yet comprehensive presentation to understand the concept of CRRT and its implementation in Intensive Care Unit. Intended for the very beginners in ICU. After going through the presentation you will be able to say "Now I know it!"
- English version of this lecture is available at:
https://youtu.be/V3UGzJTwAWw
- Arabic version of this lecture is available at:
https://youtu.be/hGLaUde2ue4
- Visit our website for more lectures: www.NephroTube.com
- Subscribe to our YouTube channel: www.youtube.com/NephroTube
- Join our facebook group: www.facebook.com/groups/NephroTube
- Like our facebook page: www.facebook.com/NephroTube
- Follow us on twitter: www.twitter.com/NephroTube
Hemostasis, Coagulation, Intrinsic, Extrinsic & common Pathways of Clotting, Common bleeding disorders & their investigations, BT, CT, PT, APTT, TT, Blood & its products, Blood transfusion & its complication.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3. Plasma exchange is the removal of plasma from a
patient and replacement by fresh-frozen or stored
plasma.
The terms "plasma exchange" and
"plasmapheresis" are often used inter-changeably.
Basic Plasmapheresis
4. Mechanism Example of diseases
Removal of circulating pathologic factors
Antibodies Antiglomerular basement membrane
disease
Immune complexes Lupus nephritis
Cryoglobulin Cryoglobulinemia
Myeloma protein Myeloma cast nephropathy
Prothorombotic factors Hemolytic uremic syndrome /
thrombotic thrombocytopenic purpura
Possible mechanisms of action
of plasmapheresis
5. Mechanism Example of diseases
Replacement of deficient plasma factors
Antithrombotic or fibrinolytic factor HUS/TTP
Possible mechanisms of action
of plasmapheresis
Effects on the immune system
Removal of complement products Lupus nephritis
Effect on immune regulation Transplantation
Improvement in reticuloendothelial function Cryoglobulinemia
6. Techniques of Plasmapheresis
1. Centrifugal cell separators
Withdraw plasma from a spinning bowel with
either continuous or intermittent return of
blood cells to the patient.
Can be done through a single needle in the
anticubital vein.
7.
8.
9.
10.
11.
12. Centrifugation takes advantage of the different
specific gravities inherent to various blood
products, such as red blood cells (RBCs), white
blood cells (WBCs), platelets, and plasma.
13. Techniques of Plasmapheresis
2. Membrane Plasmafiltration:
Uses highly permeable membranes through
which blood is pumped at 100-150 ml/min.
Plasma passes through the membrane pores,
whilst the cells are simultaneously returned to
the patient.
14. Techniques of Plasmapheresis
2. Membrane Plasmafiltration:
All immunoglobulins will cross the membrane
IgG more efficiently than IgM, however some
large immune complexes and some
cryoglobulins may not be adequately cleared.
15. Membrane plasma
separation uses
differences in particle size
to filter plasma from the
cellular components of
blood.
16. Secondary membrane plasma fractionation can
selectively remove undesired macromolecules,
which then allows return of the processed plasma to
the patient instead of donor plasma or albumin.
Examples of secondary membrane plasma
fractionation include cascade filtration,
thermofiltration, cryofiltration, and low-density
lipoprotein pheresis.
17. Anticoagulation:
Either heparin or citrate.
Heparin requirement are double that for HD due
to loss in plasma.
• loading 70-80 units/kg followed by
• 1500 units/h infusion.
21. Choice of replacement solution
Solution Advantage Disadvantage
Albumin • No risk of hepatitis
• Allergic reactions rare
• No concern about ABO
blood group
• Expensive
• No coagulation factors
• No immunoglobulins
Fresh frozen
plasma
• Coagulation factors
• Immunoglobulins
• “Beneficial” factors
complement
• Risk of hepatitis
• Allergic reactions
• Must be ABO
compatible
• Citrate loaad
22. Myriad conditions that fall into this category (including
neurologic, hematologic, metabolic, dermatologic,
rheumatologic, and renal diseases, as well as
intoxications) can be treated with plasmapheresis.)
Indications
23. The Apheresis Applications Committee of the American
Society for Apheresis periodically evaluates potential
indications for apheresis and categorizes them from I
to IV in the basis of the available medical literature.
The following are some of the indications, and their
categorization, from the society’s 2010 guidelines.
Indications
24. Category I (disorders for which apheresis is accepted
as first-line therapy, either as a primary standalone
treatment or in conjunction with other modes of
treatment) are as follows:
Guillain-Barre syndrome
Myasthenia gravis
Chronic inflammatory demyelinating polyneuropathy.
Indications
25. Hyperviscosity in monoclonal gammopathies
Thrombotic thrombocytopenic purpura
Goodpasture syndrome (unless it is dialysis-
dependent and there is no diffuse alveolar
hemorrhage).
Hemolytic uremic syndrome (atypical, due to
autoantibody to factor H)
Wilson disease, fulminant
Cont.……
26. Category II (disorders for which apheresis is accepted as
second-line therapy, either as a standalone treatment or in
conjunction with other modes of treatment) are as follows:
Lambert-Eaton myasthenic syndrome
Multiple sclerosis (acute central nervous system
emyelination disease unresponsive to steroids)
RBC alloimmunization in pregnancy
Mushroom poisoning
Indications
28. Category III (optimum role of apheresis therapy is not
established; decision-making should be individualized) are
as follows:
Posttransfusion purpura
Autoimmune hemolytic anemia (warm autoimmune
hemolytic anemia)
Hypertriglyceridemic pancreatitis
Thyroid storm
29. Category IV (disorders in which published evidence
demonstrates or suggests apheresis to be ineffective or
harmful; institutional review board [IRB] approval is
desirable if apheresis treatment is undertaken in these
circumstances) are as follows:
Stiff person syndrome
Hemolytic uremic syndrome (typical diarrhea-associated)
Systemic lupus erythematosus (nephritis)
Immune thrombocytopenia
30. Contraindications
Plasmapheresis is contraindicated in the following patients:
Patients who cannot tolerate central line placement
Patients who are actively septic or are hemodynamically
unstable
Patients who have allergies to fresh frozen plasma or
albumin depending on the type of plasma exchange
Patients with heparin allergies should not receive heparin
as an anticoagulant during plasmapheresis.
31. Contraindications cont.…..
Patients with hypocalcemia are at risk for worsening of
their condition because citrate is commonly used to
prevent clotting and can potentiate hypocalcemia
Patients taking angiotensin-converting enzyme (ACE)
inhibitors are advised to stop taking the medication for
at least 24 hours before starting plasmapheresis
32. Complications of plasmapheresis
1. Related to vascular access
Hematoma
Pneumothorax
Retroperitoneal bleed.
2. Related to the procedure
Hypotension
Bleeding
Edema
Loss of cellular elements (platelets)
Hypersensitivity reactions
33. Complications of plasmapheresis
3. Related to anticoagulation:
Bleeding
Hypocalcemic symptoms
Tingling and numbness
Arrythmias
Hypotension
Metabolic alkalosis from citrate.
34. Complications
Patients may also be at further risk for developing
hypotension if they have a history of taking
angiotensin-converting enzyme (ACE) inhibitors, in
particular while undergoing column-based
plasmapheresis.
35. Complications
The suspected mechanism is related to increased
bradykinin levels caused by use of ACE inhibitors. This
accumulation of kinins leads to hypotension, flushing,
and gastrointestinal symptoms.
Patients are therefore advised to stop all ACE inhibitors
at least 24 hours before starting plasmapheresis.
36. General orders for plasmapheresis
1. Calculate the plasma volume
2. Measure PT, PTT, platelets
3. When feasible, measure the plasma level of the
substance targeted for removal (e.g.
antiglomerular basement membrane antibody titre,
acetylcholine receptor antibody, cryoglobulin)
4. Space treatments approximately 24 h apart.
37. General orders for plasmapheresis
6. Myeloma with cast nephropathy
7. Crescentic IgA glomerulonephritis
8. For heparin anticoagulation 50 units/kg initially
then, 1000 units/hr
Target Activated clotting time 180-220 sec
(baseline 145 sec)
38. General orders for plasmapheresis
8. For citrate anticoagulation, use ACD-A
at 1:15 to 1:25 dilution with blood.
Use calcium infusion if necessary
Cardiac monitor
9. Administer scheduled medications only at the
end of the session.
10.Catheter care as routine.
39. Performance of Plasma filtration
Priming:
1. Heparinized isotonic saline 5000 IU/L
2. Deareation
3. In the blood compartment discard the initial 300
ml of the liquid
4. In the filtrate compartment at least 500 ml saline
solution should be filtered across the membrane
and discarded.
5. Attach the filtrate tubing system at the upper
filtrate port prior to the connection of the blood
line system.
40. Performance of Plasma filtration
Patient connection:
1. Connect the arterial blood tubing system.
2. Allow blood to flow until all saline solution
expelled.
3. Blood flow rate 100 mL/min.
4. Connect the venous blood tubing system.
5. Circulate blood for approximately 3 min without
filtration.
6. Filtrate flow should not exceed 20% of the blood
flow rate.
41. Performance of Plasma filtration
Termination of plasma filtration:
The blood should be completely reinfused with
saline to the patient. (Pump max 100 mL/min)
Return rates of blood product are on the order of
1.5 mL/kg/min, as opposed to the standard 70
mL/min flat rate used in adults.
42. Performance of Plasma filtration
Main problems.
Hemolysis
Indicated by red colouration of filtrate.
TMP should be decreased under 80 mmHg.
reduce filtrate flow.
reduce blood flow.
Blood leak
Allow blood to recirculate for some minutes without
filtration.
In case of a larger blood leak, the filter must be
exchanged.
43. Sepsis causes disturbances of homeostasis that lead to
excessive coagulation, systemic inflammation, and
impaired fibrinolysis. In addition, blood flow to organs
can be reduced despite adequate cardiac output because
an imbalance occurs between coagulation and
fibrinolysis, resulting in impaired tissue perfusion.
ADJUNCTIVE USE OF PLASMAPHERESIS AND INTRAVENOUS
IMMUNOGLOBULIN THERAPY IN SEPSIS: A CASE REPORT
44. A newer therapy, administration of drotrecogin alfa
(activated), treats the pathophysiological consequences
of severe sepsis: inflammation, coagulation, and
impaired fibrinolysis.
but use of the agent increases the risk of bleeding and
so its appropriateness must be determined on an
individual basis.
ADJUNCTIVE USE OF PLASMAPHERESIS AND INTRAVENOUS
IMMUNOGLOBULIN THERAPY IN SEPSIS: A CASE REPORT
45. Institutional indications for plasmapheresis in patients
with necrotizing soft tissue infection
Patient must have one of the following:
White blood cell count >30.0 x 109/L
Serum creatinine level >177 µmol/L (2 mg/dL) at time of
admission
Hypotension with systolic blood pressure <90 mm Hg
or dependence on inotropes and/or vaopressors
Acute respiratory failure
46. Plasmapheresis removes large, harmful molecules such
as pathogenic autoantibodies, endotoxins, and
proinflammatory cytokines.
If IV Ig is used, it should be given after plasmapheresis,
because it would be removed during plasmapheresis.
Intravenous immune globulin provides passive, temporary
immunity for patients with sepsis, who frequently have serum
globulin levels in the low normal range.
47. Most of the research available on use of
plasmapheresis and IV Ig in patients with NSTI and/or
toxic shock syndrome indicates that this combination
provides some improvement in these patients.
However, no large controlled trials have been done
that would provide statistical support for the clinical
efficacy of this combination of therapies.