Presentation on Plasmapheresis

2. PLASMAPHERESIS
• PLASMAPHERESIS
• DEFINITION;
• Plasmapheresis is an experimental procedure conducted in animals to explain about the importance of
plasma proteins

3. • PROCEDURE:-
• This experiment was conducted in dogs. The blood is completely eliminated from the body of dog. The
separation of red blood cells takes place from plasma and the separated red blood cells washed
particularity in saline and re infused into the body of the same dog along with a physiological solution
termed as Lockes solution.
• Because of thew sudden lack of proteins, shock is observed in the animal.When the fed with diet
consisting of high quality of proteins in a sufficient manner, the restoration of the normal level of proteins
happens particularly within seven days and the animal survives. The synthesis of new plasma proteins takes
place particularly by the liver of the dog.
• When the experiment is conducted in animals particularly after the removal of liver, in spite of the diet
consists of the quantity of proteins in an adequate manner, the plasma proteins are not produced. The shock
retains in the animal and results in death
• So, the experimental plasmapheresis is helpful in demonstrating
• The value of plasma proteins for survival
• The synthesis of plasma proteins by the liver

4. • CLINICAL SIGNIFICANCE OF PLASMAPHERESIS- THERAPEUTIC PLASMA EXCHANGE:
• INTRODUCTION;_ Plasmaphertesis is used as a blood Purification procedure for an effective treatment of
many auto immune diseases especially for temporry period. It is also termed as therapeutic plasma
exchange.
• In an auto immune disease, the immune system invaders the bodys own tissues with the help of
antibodies. The antibodies that are protein in nature circulate especially in the bloodstream before
invading the target tissues.Plasmapheresis is helpful in eliminating these antibodies from the blood
• PROCEDURE
• Fist of all venous blood is eliminated especially drom the patient and the separation of blood cells happens
especially by the equipment termed as cell separator. This technique works on a principleof a centrifuge.
• After remobal from the body, an anti coagulant is added to stop the clotting of blood. The plasma musty be
discarded after the separation of blood cells. The blood cells are returned to blood stream of the patient by
mixing with a substitute fluid ( saline ) and sterilized human albumin protein

5. list of various indications for plasmapheresis, along with their ASFA( American Society for Apheresis) category
• Category 1
•
• Acute inflammatory demyelinating polyradiculoneuropathy/Guillain-Barre syndrome
•
• ANCA-associated rapidly progressive glomerulonephritis (dialysis-dependent or associated with diffuse alveolar hemorrhage)
•
• Anti-glomerular basement membrane disease-Goodpasture syndrome (dialysis independent or associated with diffuse alveolar
hemorrhage)
•
• Chronic inflammatory demyelinating polyradiculoneuropathy
•
• Focal segmental glomerulosclerosis (recurrent in the transplanted kidney)
•
• Hyperviscosity in monoclonal gammopathies
•
• Liver transplantation: Desensitization

6. • Myasthenia gravis
•
• N-methyl D-aspartate receptor antibody encephalitis
•
•
• Paraproteinemic demyelinating neuropathies/chronic acquired demyelinating polyneuropathies (IgA/IgG/IgM mediated)
• Progressive multifocal leukoencephalopathy associated with natalizumab
•
• Renal transplantation: Desensitization and antibody-mediated rejection
•
• Thrombotic microangiopathy (Factor H autoantibodies and ticlopidine)
•
• hrombotic thrombocytopenic purpura
•
• Wilson disease (fulminant)
•

7. Category 2
• Category 2
• Acute disseminated encephalomyelitis
• Cardiac transplantation: Desensitization
•
• Catastrophic antiphospholipid syndrome
•
• Cryoglobulinemia; symptomatic/severe
•
• Dilated cardiomyopathy, idiopathic (NYHA 2-4)
•
• Hashimoto encephalopathy: Corticosteroid responsive encephalopathy
associated with autoimmune thyroiditis
•
• Hematopoietic

8. • stem cell transplantation, ABO-incompatible
• Lambert-Eaton myasthenic syndrome
• Multiple sclerosis
• Myeloma cast nephropathy
• Neuromyelitis Optica spectrum disorders
• Overdose, envenomation, and poisoning, such as mushroom
• Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
(PANDAS)
•
• Phytanic acid storage disease (Refsum disease
•
• Systemic lupus erythematosus (severe)

9. • Category 3
• Acute liver failure
• ANCA-associated rapidly progressive glomerulonephritis (dialysis independent)
• Anti-glomerular basement membrane disease, Goodpasture syndrome (dialysis-dependent, no
DAH)
• Aplastic anemia, pure red cell aplasia
• Autoimmune hemolytic anemia
• Burn shock resuscitation
• Cardiac neonatal lupus

10. • Cardiac transplantation: Antibody-mediated rejection
•
• Chronic focal encephalitis (Rasmussen encephalitis)
•
• Complex regional pain syndrome; chronic
•
• Erythropoietic porphyria, liver disease
• Hemolysis liver enzymes low platelet (HELLP) syndrome (postpartum)
•
• Hematopoitic stem cell transplantation, HLA desensitization
•
• Hemophagocytic lymphohistiocytosis; hemophagocytic syndrome; macrophage activating
syndrome

11. • Henoch-Schonlein purpura
•
• Heparin-induced thrombocytopenia and thrombosis
•
• Hypertriglyceridemic pancreatitis
•
• Immune thrombocytopenia; refractory
•
• IgA nephropathy; crescentic
•
• Lung transplantation: Desensitization and antibody-mediated rejection
•
• Paraneoplastic neurological syndromes
•
• Pemphigus Vulgaris; severe
•

12. • Pruritus due to hepatobiliary diseases
• Scleroderma (systemic sclerosis)
• Sepsis with multiorgan failure
• Stiff-person syndrome
• Thrombotic microangiopathy (complement factor gene mutations, MCP mutations,
clopidogrel, and calcineurin inhibitors)
• Thyroid storm
• Toxic epidermal necrolysis (refractory)
• Vasculitis
• Voltage-gated potassium channel antibodies

13. • Category 4
• Amyloidosis, systemic
•
• Dermatomyositis/polymyositis
•
• HELLP syndrome (antepartum)
•
• Lupus nephritis
•
• Thrombotic microangiopathy (gemcitabine and quinine)

14. • Contraindications
• The contraindications for therapeutic plasmapheresis are as follows:
• Non-availability of central line access or large bore peripheral lines
•
• Hemodynamic instability or septicemia
• Known allergy to fresh frozen plasma or replacement colloid/albumin
•
• Known allergy to heparin
• Hypocalcemia (restricts the use of citrate as an anticoagulant during the procedure);
relative contraindication
•
• Angiotensin-converting enzyme (ACE) inhibitor used in last 24 hours; relative
contraindication

15. • USES OF PLASMAPHERESIS
• Even though plasmapheresis is helpful in eliminating antibodies especially from the blood, it can nor stop the
production of antibodies especially by the immune system of the body. That is why, it can give protection to the
tissues from the antibodies for a temporary period. The patient must undergo for repeated sessions of the
treatment. Plasmapheresis is an effective treatment for the following diseases for a temporary period.
• CHRONIC DEMYELINATING POLY NEUROPATHY :- It is a neurological disorder manifested by progressive weakness
as well as impaired sensory function especially in the legs and because of the damage of the myelin sheath
particularly in peripheral nerves.
• GUILLAIN-BARRE SYNDROME:- IT is an auto immune disease causing weakness and an abnormal sensations
(like tingling) especially in the limbs and paralysis takes place.
• LAMBERT-EATON MYASTHENIC SYNDROME:- It is an auto immune disorder of the neuro muscular junbction.
• MYASTHENIA GRAVIS:-Is is an auto immune disease and it is responsible for causing muscle weakness.
• PARA PROTEINEMIC NEUROPATHY:- It is a disorder of peripheral nervous system because of an abnormal immuni
globulin terned as paraprotein.
• THROMBOCYTOPENIC PURPURA:- It is a bleeding disorder.

16. • References
• Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis. 2008 Dec;52(6):1180-96. [PubMed]
• 2Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the
Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher. 2016 Jun;31(3):149-62. [PubMed]
• Gerhardt RE, Ntoso KA, Koethe JD, Lodge S, Wolf CJ. Acute plasma separation with hemodialysis equipment. J Am Soc Nephrol. 1992 Mar;2(9):1455-8. [PubMed]
• 4.
• Siami GA, Siami FS. Membrane plasmapheresis in the United States: a review over the last 20 years. Ther Apher. 2001 Aug;5(4):315-20. [PubMed]
• 5.
• Gurland HJ, Lysaght MJ, Samtleben W, Schmidt B. A comparison of centrifugal and membrane-based apheresis formats. Int J Artif Organs. 1984 Jan;7(1):35-8. [PubMed]
• 6.
• Pham HP, Staley EM, Schwartz J. Therapeutic plasma exchange - A brief review of indications, urgency, schedule, and technical aspects. Transfus Apher Sci. 2019 Jun;58(3):237-246. [PubMed]
• 7.
• Mokrzycki MH, Kaplan AA. Therapeutic plasma exchange: complications and management. Am J Kidney Dis. 1994 Jun;23(6):817-27. [PubMed]
• 8.
• Owen HG, Brecher ME. Atypical reactions associated with use of angiotensin-converting enzyme inhibitors and apheresis. Transfusion. 1994 Oct;34(10):891-4. [PubMed]
• 9.
• Nguyen TC, Kiss JE, Goldman JR, Carcillo JA. The role of plasmapheresis in critical illness. Crit Care Clin. 2012 Jul;28(3):453-68, vii. [PMC free article] [PubMed]
• 10.
• Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH., Apheresis Applications Committee of the American Society for Apheresis. Guidelines on
the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher. 2010;25(3):83-177. [PubMed]