1. Apheresis Procedures

2. Plasma pheresis Definition From greek „Apheresis“, i.e. „separation“
of plasma through membran filter or centrifuge
Dr. M. Susca

3. Overview
Dr. M. Susca

4.
Dr. M. Susca

5.
Dr. M. Susca

6. Centrifuge Separation
Primary System
Membran Filter
Separation
Centrifuge Separation
Secundary System
Throw away
Plasma Modulation
Plasma Filtration
Plasma Perfusion
Cryo-Filtration
Cascade Filtration
Dextransulfat Adsorption
Therapeutic
Plasma Exchange
Heparin Precipitation
Immuno-Adsorption
Dr. M. Susca

7.
Dr. M. Susca

8. Membrane Filter Separation
Filtration Rate <1/3 of Blood Flow Rate
Hemocompatibility
TMP <100 mmHg
Sterilisation:
ETO
Steam
Gamma
Secundary Membrane
Pore Size µm
Sueface m²
Material:
Polypropylen
Polysulfon
Cellulosediacetat
Cut-off 3 BiDa
Sieving Coefficient >0.8
Dr. M. Susca

9. Thrombocytes 2-3.5 µm Albumine 69 kDa IgG 150 kDa IgA 160 kDa
IgM 900 kDa
Fibrinogen 340 kDa
LDL kDa
0.02 µm
Membrane Pores µm
Dr. M. Susca

10. Sieving Coefficient Concentration ratio of a certain component in
separated plasma to the Concentration in plasma before seperation
Dr. M. Susca

11.
Dr. M. Susca

12. TPE - Therapeutic Plasma Exchange
Heparin V PV PA
Pl. S
BLD
SAD
Heater
Plasma Filter
PPL
SAC
Balance
Dr. M. Susca

13. Blood Access V. jugularis interna V. subclavia V. cubitalis
V. femoralis
Cimino Fistula
Dr. M. Susca

14. Anticoagulation
Dr. M. Susca

15. Tissue Factor (III) + Ca2+ (IV) + VII
Coagulation Cascade
Defect
Injury X
Endothel
Tissue
Endogen System
Exogen System
XII XI IX
Tissue Factor (III) + Ca2+ (IV) + VII
XIIa
XIa
IXa
VIII
Ca2+ (IV)
TF3
Citrate
Heparin
Thrombocytes
TF3 +
Xa + V + Ca2+ (IV)
XIII
Thrombin
Prothrombin (II)
AT III
Fibrin Monmers
Fibrinogen (I)
XIIIa
Fibrin
Dr. M. Susca

16. isovolemic, isotonic, isooncotic allergen and pyrogen free, sterile
Substitution
Clinical Requirement
isovolemic, isotonic, isooncotic
allergen and pyrogen free, sterile
containing coagulation factors and immunoglobulins
Dr. M. Susca

17. Substitution
Dr. M. Susca

18. Hemofiltration Solution
Dr. M. Susca

19. Human Albumine Electrolyte Solution
Dr. M. Susca

20. i.g. 2 Liters 4%-Solution = 400 ml Albumine 20% + 1600 ml HF Solution
Albumine Solution
HF Solution
Albumine
i.g. 2 Liters 4%-Solution = 400 ml Albumine 20% ml HF Solution
Dr. M. Susca

21. Exchange Volume
Dr. M. Susca

22. Redistribution Rebound Return Rate Distribution Space kinetics
Drugs
Dilution Effect
Rebound
Redistribution
Resynthesis
Dr. M. Susca

23. Dilution Kinetics
Dr. M. Susca

24. Distribution Volume Intracellular Space = 40%
Extracellular Space = 20%
Interstitial Space = 16%
Intravascular Space = 4%
Distribution Volume
Dr. M. Susca

25. Distribution Volume
Dr. M. Susca

26. Complications
Dr. M. Susca

27. Indications
Dr. M. Susca

28.
Dr. M. Susca

29. Cascade Filtration Plasma Filter Heparin Cascade Filter V V 16.02.04
Heater PV
PPL
BLD
SAD
SAC
Heparin
Plasma Filter V
Cascade Filter V PA
Dr. M. Susca

30. Cascade Filtration (Dead–End-Procedure)
Heater
Heparin V PV PA
BLD
SAD
Plasma Filter
PPL
SAC
Cascade Filter
Retinate Pump
Retinate Bag
Dr. M. Susca

31. Cascade Filtration (Recirculation-Procedure)
Heater
Heparin V PV PA
BLD
SAD
Plasma Filter
PPL
SAC
Cascade Filter
Recirculation Pump
Dr. M. Susca

32. Thermofiltration Plasma Filter Heparin V V 16.02.04 Dr. M. Susca PV
PPL
BLD
Heater
SAD
SAC
Heparin
Plasma Filter V
Cascade Filter V PA
Retinate Pump
Retinate Bag
Dr. M. Susca

33. PAP – Plasmaadsorption „single column“
Heater PV
PPL
BLD
SAD
SAC
Heparin
Plasma Filter V
Plasma Adsorber V PA
Particle Filter
Dr. M. Susca

34. PAP – Plasmaadsorption „double column“
Heater
Regeneration
Solution PV
PPL
BLD
SAD
SAC
Heparin
Plasma Filter V V PA
Plasma
Adsorber
Particle Filter
Dr. M. Susca