PLASMAPHERESIS 

DEFINITIONFrom the greek

Plasma,something moldedaphairesis, taking away

Is the removal and treatment of blood from the body and return of components of blood(i.e blood cells)to the body after

extraction of plasma.

ORPlasmapheresis is a blood purification

procedure used to treat several autoimmune diseases. It is also known

as therapeutic plasma exchange.

PURPOSE

In an autoimmune disease, the immune system attacks the body's own tissues.

In many autoimmune diseases, the chief weapons of attack are antibodies, proteins that circulate in the bloodstream until they meet and bind with the target tissue.

Once bound, they impair the functions of the target.

Plasmapheresis is used to remove antibodies from the bloodstream, thereby preventing them from attacking their targets.

It does not directly affect the immune system's ability to make more antibodies, and therefore may only offer temporary benefit.

INDICATIONSMAJOR

Guillain-Barré syndrome Myasthenia gravis Chronic inflammatory demyelinating

polyneuropathy Thrombotic thrombocytopenic

purpura/TTP Idiopathic thrombocytopenic purpura/ITP Dermatomyositis Good pasteur’s syndrome Multiple sclerosis

MINOR

Hyperviscosity syndromes:

1. Cryoglobulinemia2. Paraproteinemia

Wegener's granulomatosis Lambert-Eaton Syndrome Antiphospholipid Antibody Syndrome

(APS or APLS) Microscopic polyangiitis After transplantation of kidney

Behcet syndrome HIV-related neuropathy [8] Graves' disease in infants and neonates Pemphigus vulgaris Multiple sclerosis Rhabdomyolysis Toxic Epidermal Necrolysis (TEN) HELLP syndrome PANDAS syndrome Refsum disease

PLASMAPHERESIS AND PLATELETS EXCELLENCE CENTRE OF AIMC/JHL

CELLSEPARATOR The machine used for Plsmapheresis is

called cell separator. 40,00,000 (40 lakh) Expire in 2 to 3 years. Each time new set of tubing and

disposable kit is used, which is of 13,500

rupees.

PROCEDUREPREPARATION Good nutrition and plenty of rest make the

procedure less stressful. Some of patient's medications should be

discontinued before the plasmapheresis session.

SETPS Plasmapheresis requires insertion of a venous

catheter, either in a limb or central vein. Central veins allow higher flow rates and are

more convenient for repeat procedures, but are more often the site of complications, especially bacterial infection.

Blood is initially taken out of the body through a needle or previously implanted catheter.

The catheter is two way,one is used to withdraw blood from the body and other is used to introduce plasma substitute in patient,s body.

Anticoagulant is also given during the procedure. First blood passes through the air filter,if air is

present in blood it is filtered here. Then blood enters into ball(centrifuge). Plasma is

then removed from the blood by a cell separator. When the blood is entering in the ball,at the same

time some air of ball is collected in air bag.

After sometime,when ball becomes full of cells the machine takes a break and blood cells are returned back to the body,and air is returned back from the airbag to the the ball.

Now 1 cycle is completed. Same process is repeated again and again

and mostly 8 to 10 cycles are required. Extracted plsma is discarded. In females less no.of cycles are required. The whole procedure is repeated 5 times

but on alternate days.

Three procedures are available: "DISCONTINUOUS FLOW

CENTRIFUGATION." Only one venous catheter line is required. Approximately 300 ml of blood is removed at a time and centrifuged to separate plasma from blood cells.

"CONTINUOUS FLOW CENTRIFUGATION." Two venous lines are used. This method requires slightly less blood volume to be out of the body at any one time.

"PLASMA FILTRATION." Two venous lines are used. The pasma is filtered using standard hemodialysis equipment. It requires less than 100 ml of blood to be outside the body at one time.

AFTERCARE The patient may experience

dizziness,nausea, numbness, tingling, or lightheadedness during or after the procedure. These effects usually pass quickly, allowing the patient to return to normal activities the same day.

COMPLICATIONS Hypotention Anaphylaxsis or allergic reactions Bacterial infections Supression of immune system Bleeding or hematoma due to

anticoagulant