The Art of Plasmapheresis - Perfusion.com
The Art of Plasmapheresis - Perfusion.com
The Art of Plasmapheresis - Perfusion.com
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<strong>The</strong> <strong>Art</strong> <strong>of</strong> <strong>Plasmapheresis</strong><br />
Aníbal M. Marín CCP MBA GM<br />
HIMA San Pablo Hospital<br />
Centro Cardiovascular de PR
<strong>Plasmapheresis</strong><br />
•Extracorporeal<br />
procedure used to<br />
remove antibodies<br />
from the<br />
bloodstream.<br />
•<strong>The</strong>rapeutic plasma<br />
exchange
<strong>Plasmapheresis</strong><br />
•1902 animal<br />
experimentation.<br />
•1924 John J. Abel<br />
described dog’s separation<br />
and reinfusion.<br />
•In 1931 continuous<br />
plasmapheresis was<br />
performed.<br />
•Since 1960 in humans
<strong>Plasmapheresis</strong><br />
•Two main types:<br />
•Centrifugation<br />
•Cytapheresis<br />
•Since 1930 (animals)<br />
•Since 1960 (humans)<br />
•Membrane Filtration<br />
•Since 1970<br />
•Similar to dialysis
<strong>Plasmapheresis</strong><br />
Useful in treatment <strong>of</strong>:<br />
•Guillain-Barre Syndrome<br />
•Myasthenia Gravis<br />
•Multiple Sclerosis<br />
•Thrombotic<br />
Thrombocytopenia<br />
Purpura (TTP)<br />
•Other Autoimmune<br />
Disorders
<strong>Plasmapheresis</strong><br />
•20 years experience<br />
•Guillain-Barre…….....80<br />
•Myasthenia Gravis..132<br />
•Multiple Sclerosis…..51<br />
•TTP…………………..53<br />
•Sjogrens Disease……2<br />
•Multiple Myeloma……2<br />
•Heart Transplant..…...2
<strong>Plasmapheresis</strong><br />
What do you need?<br />
•Quinton Catheter<br />
•Good venous access<br />
•Administration Approval<br />
•Contract<br />
•Compensation $800.00<br />
•CPT code 36515
<strong>Plasmapheresis</strong><br />
Patient Evaluation:<br />
•Diagnosis<br />
•Hematocrit<br />
•>24.0%<br />
•Platelets<br />
•>50,000<br />
•Albumin or FFP
<strong>Plasmapheresis</strong><br />
Estimate EBV and PV:<br />
•Weight in Kg<br />
•Hematocrit %<br />
•Formula <strong>of</strong> EBV<br />
•Kg x constant (70)<br />
•Plasma Volume (PV)<br />
•EBV x Hct = RBCv<br />
•EBV – RBC = PV
<strong>Plasmapheresis</strong><br />
•Exchange <strong>of</strong> 1X<br />
the EBV = 64% reduction<br />
in Ab concentrations<br />
•Exchange <strong>of</strong> 1.5X<br />
the EBV = 78% reduction<br />
in Ab concentrations
<strong>Plasmapheresis</strong><br />
Catheter Placement:<br />
•Done by a Surgeon<br />
•X Ray verified<br />
•Sterile Technique<br />
•Bed side
<strong>Plasmapheresis</strong><br />
•Machines and Methods?<br />
•Manually<br />
•MCS – Haemonetics<br />
•COBE Spectra<br />
•ACCURA (Baxter)<br />
•Plasmaflo Asahi
<strong>Plasmapheresis</strong><br />
•Techniques:<br />
•Blood Pressure<br />
•Heart Rate<br />
•Fluids Balance<br />
•Input = Output<br />
•Speed<br />
•50 – 100ml/pm
<strong>Plasmapheresis</strong><br />
•Possible Complications:<br />
•Hypotension<br />
•Fluid Imbalance<br />
•Tachycardia<br />
•Compensation<br />
•Chills<br />
•Anaphylaxis<br />
•Citrate Toxicity (CPDA)
<strong>Plasmapheresis</strong><br />
•Thrombotic<br />
Thrombocytopenia Purpura<br />
(TTP)<br />
•Hematologic Disorder<br />
•Presence <strong>of</strong><br />
Procoagulant Factor<br />
•Absence <strong>of</strong><br />
Antithrombotic Factor<br />
•Low PLT<br />
•Done with FFP
<strong>Plasmapheresis</strong><br />
•Guillan Barre<br />
•AKA<br />
•Acute demyelinating<br />
polyneuropathy<br />
•Virus URTI or<br />
Stomach Virus<br />
•Spinal Fluid Protein<br />
•Done with Albumin
<strong>Plasmapheresis</strong><br />
•Myasthenia Gravis<br />
•Autoimmune<br />
•Acetylcholine Ab<br />
•Done with Albumin
<strong>Plasmapheresis</strong><br />
•Heart Transplant<br />
Rejection<br />
•Pre-Post Transplant<br />
•Prevent Acute Rejection<br />
• Anti donor spec-Ab<br />
• Done with Albumin
<strong>Plasmapheresis</strong><br />
•Who can perform a<br />
plasmapheresis therapy?<br />
•<strong>Perfusion</strong>ists<br />
•Dyalisis Nurses
Any Questions?
<strong>Plasmapheresis</strong><br />
• References<br />
A. Marin et.al. <strong>The</strong> <strong>Art</strong> <strong>of</strong> <strong>Plasmapheresis</strong> Manual 2010<br />
Sowada, K, Malchesky, PS, Nose, Y. Available removal systems: State <strong>of</strong> the<br />
art. In: <strong>The</strong>rapeutic Hemapheresis in the 1990s, Nydegger, UE (Ed), Curr<br />
Stud Hematol Blood Transf, Karger, Basel, 1990, No 57, pp. 51-113.<br />
Grapsa Eirini MD, University <strong>of</strong> Athens, Greece<br />
Is <strong>The</strong>rapeutic Plasma Exchange still a useful treatment,<br />
cin2009.uninet.edu/en/trabajos/show Retrieved in January 2010
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