1. Nephrology Specialist at New Mansoura General Hospital
PLASMAPHERESIS By
Dr.Mohamed Abd El Gawad
Nephrology Specialist at New Mansoura General Hospital

2. Agenda What is Plasmapheresis ? INDICATIONS FOR PLASMAPHERESIS
TECHNIQUES
Replacement fluid
Vascular access
Anticoagulation
Regimens of PE
Complications

3. What is Plasmapheresis ?

5. INDICATIONS FOR PLASMAPHERESIS

10. TECHNIQUES
A: Centrifugal plasma separation : blood cells are separated during centrifugation , there are two centrifugation methods Intermittent flow device and continuous flow device
B: membrane plasma separation : plasma separators use membranes with a molecular weight 3 million

14. membrane plasma separation
  Uses highly permeable hollow fibers with membrane pores of 0.2to 0.5 µm.
 The hollow fiber functions as a membrane, with the pore size (0.2to 0.5 µm) allowing transport of plasma across the membrane while retaining other blood components.
PlasmaFlux filters contain the polysulfone-based Plasmasulfone membrane, which has been designed to minimise the activation of the patient’s immune system during blood–­membrane interaction

17. Serum Albumin
Serum Albumin : 4 g /dL
40 g /L
40 × 3 = 120 g /3L

18. Electrolytes
Calcium: 10 ml of calcium gluconate solution per liter of replacement solution Potassium : 4 mmol of Potassium to each liter of replacement solution

19. Vascular access Standard central venous catheters
Arteriovenous(AV) fistula
Peripheral access through large-bore, short, intravenous cannulae

20. Anticoagulation 1 - Citrate IT is used for centrifugal plasma exchang.
citrate has particular advantages in patients at higher bleeding risk in view of its lack of systemic anticoagulant actions.
Citrate is rapidly metabolized by the liver (normal levels
within 4 hours).
Hepatic dysfunction ⇒ severe hypocalcemia

21. Used for membrane plasma filtration
2 – Heparin
  Used for membrane plasma filtration
Higher doses may be needed than in hemodialysis as a result of increased losses during the procedure (heparin is protein bound).
Bolus doses of unfractionated heparin 2000 to 5000 U
are given initially, and then 500 to 2000 U/h.

22. Frequency of procedures
Regimens of PE?
Volume of exchange
1-1.5 plasma volume
Frequency of procedures
Duration of therapy

23. Plasma volume Plasma volume = ( 0.07 × Body Weight ) × ( 1 - Hct )
( 0.07 × 70 ) × ( )
= 2.9 L

24. Frequancy of procedures
1- Daily plasma exchange
Most effective in rapidly depleting total body load.
Intensity of exchanges has no major effect on outcomes except in hemolytic-uremic syndrome.
2- Alternate-day exchanges
proven efficacy in antineutrophil cytoplasmic antibody (ANCA)–associated diseases.

26.  A single plasma volume exchange will lower plasma macromolecule levels by approximately 60% .
Five exchanges during 5 to 10 days will clear 90% of the total body Immunoglobulin

27. Target molecule kinetics during therapeutic plasma exchange.
Target molecule kinetics during therapeutic plasma exchange. (A) Theoretical relationship between an increasing plasma volume exchanged relative to the patient’s plasma volume during the TPE procedure, and the percentage decrease in the concentration of the target molecule under idealized conditions. (B) Similar figure showing removal of target molecule from the beginning (closed circles) to the end of each of three TPE procedures (open circles), now taking into account factors such as biosynthesis, catabolism, and compartmental equilibration. Adapted from Kaplan (1) and Samtleben et al. (2). TPE, therapeutic plasma exchange.
Mark E. Williams, and Rasheed A. Balogun CJASN doi: /CJN
©2013 by American Society of Nephrology

31. THANK YOU