Therapeutic Apheresis

Question 1

who publishes guidelines and recommendations for use of therapeutic apheresis in clinical practice?

Answer 1

American Society for Apheresis

Question 2

who provides standards for voluntary compliance of therapeutic apheresis?

Answer 2

AABB

Question 3

what standard defines regulations that govern apheresis activities for donors?

Answer 3

5.5 and 5.6

Question 4

donor requirements for infrequenct plasmapheresis

Answer 4

collected for direct transfusion; minimum 4 weeks between donations

Question 5

donor requirements for frequent plasmapheresis

Answer 5

minimum 2 day interval between donations
maximum 2 donations within 7 day period
limits to max volume removed per weight
max red cell loss 25 mL/week

Question 6

what is source plasma?

Answer 6

plasma from serial donors, not used for direct transfusion

Question 7

plateletpheresis donor requirements

Answer 7

meet allogeneic whole blood donor requirements
meet apheresis requirements
starting platelet count >150,000/uL
no aspirin within 48 hours of donation

Question 8

plateletpheresis storage

Answer 8

5 day shelf life at 20-24C with gentle agitation; 4 hours open system

Question 9

plateletpheresis donor requirements

Answer 9

minimum 8 weeks from whole blood donation
minimum 2 days between donations
maximum 2 donations within 7 day period
maximum 24 donations in 12 month period

Question 10

how long after whole blood donation can a donor donate plateletpheresis?

Answer 10

8 weeks

Question 11

how long after plateletpheresis can another single platelet be donated?

Answer 11

2 days

Question 12

how many plateletpheresis donations are allowed in a 7 day period?

Answer 12

2

Question 13

one plateletpheresis is equivalent in platelet count to how many platelet concentrates?

Answer 13

6-8

Question 14

what is minimum platelet count per apheresis unit?

Answer 14

3x10^11

Question 15

plateletpheresis must be suspended in enough plasma to maintain what pH?

Answer 15

6.2

Question 16

donor height and weight requirement for red cell apheresis

Answer 16

must meet requirement of manufacturer of equipment used to collect apheresis

Question 17

minimum age for red cell apheresis

Answer 17

17 years old

Question 18

donor hematocrit for red cell apheresis

Answer 18

.40% male and female

Question 19

donation interval between red cell apheresis units

Answer 19

16 weeks between donations

Question 20

indications for leukapheresis

Answer 20

septicemia

severe neutropenia

Question 21

why is hydroxyethyl starch added to apheresis circuit during leukapheresis?

Answer 21

promotes rouleaux to allow better separation of red cells and white cells

Question 22

what is given to donors 8-12 hours before leukapheresis procedure to increase granulocyte harvest?

Answer 22

corticosteroids to move granulocytes into circulation

G-CSF to stimulate production of granulocytes

Question 23

are granulocyte units crossmatched?

Answer 23

yes due to RBC contamination

Question 24

are granulocytes leukoreduced?

Answer 24

no

Question 25

are granulocytes irradiated?

Answer 25

yes

Question 26

granulocyte yield of leukapheresis

Answer 26

>1x10^10

Question 27

leukapheresis storage

Answer 27

20-24C without agitation up to 24 hours after collection

Question 28

how long can granulocytes be stored after collection?

Answer 28

24 hours

Question 29

goal of therapeutic apheresis

Answer 29

treat certain conditions/diseases through removal of blood compnents/pathologic substances

Question 30

single blood volume therapeutic apheresis will get rid of what volume of pathologic substance?

Answer 30

two-thirds

Question 31

apheresis mode: removal of whole blood --> centrifuge --> plasma taken off and discarded --> red cells re-infused along with replacement fluid

Answer 31

manual

Question 32

apheresis mode: specialized device controls rate which blood is withdrawn, anticoagulation, separation, replacement fluids, and blood return. Separation occurs through centrifugation and filtration

Answer 32

automated

Question 33

apheresis mode: rotating channel, resulting in layers of plasma, platelets, leukocytes or red cells that can be removed selectively. removed component is diverted into separate bag; remaining components along with replacement fluid is re-infused back into patient

Answer 33

continuous flow

Question 34

apheresis mode: whole blood withdrawn, extracorporeal blood component processed, centrifugation, selected component taken off, remaining components along with replacement fluid re-infused back into patient

Answer 34

intermittent centrifugation

Question 35

apheresis mode: continuous flow operation; whole blood processed through microporous filter, plasma passes through, red cells retained. hollow filtration used to wash/remove immunoglobulins

Answer 35

filtration device

Question 36

apheresis mode: whole blood passes through a medium of high affinity for specific components, effluent returned to patient

Answer 36

selective adorption

Question 37

most commonly used anticoagulant in apheresis

Answer 37

citrate

Question 38

why is calcium administered during apheresis return procedure?

Answer 38

citrate binds calcium and causes hypocalcemia

Question 39

category I indications for apheresis

Answer 39

apheresis is standard, primary therapy

Question 40

category II indication for apheresis

Answer 40

apheresis is acceptable, supportive therapy

Question 41

category III indication for apheresis

Answer 41

apheresis is not well established, individualized therapy

Question 42

category IV indication for apheresis

Answer 42

apheresis is ineffective or harmful

Question 43

main indication for therapeutic plasma exchange

Answer 43

hyperviscosity

Question 44

disease states associated with hyperviscosity needing TPE

Answer 44

TTP, Waldenstrom's macroglobulinemia, Myasthenia gravis, Guillain-Barre, Goodpastures syndrome, solid organ transplant

Question 45

replacement fluids used with TPE

Answer 45

5% albumin, 5% albumin and normal saline, donor plasma, cryopoor plasma

Question 46

how many TPE procedures are usually required to remove 90% of IgG antibodies?

Answer 46

~5 procedures of 1.5 blood volumes

Question 47

how many TPE procedures are usually required to remove 90% of IgM antibody?

Answer 47

2-3

Question 48

rare blood disorder characterized by clotting in small blood vessels of the body resulting in low platelet count

Answer 48

thrombotic thrombocytopenic purpura

Question 49

TTP pentad of symptoms

Answer 49

``` microangiopathic hemolytic anemia thrombocytopenic purpura neurologic abnormalities fever renal disease ```

Question 50

mechanism of TTP

Answer 50

IgG antibody directed against ADAMTS13 enzyme

Question 51

what happens without ADAMTS13 in TTP?

Answer 51

large multimers of vWF accumulate and cause red blood cell hemolysis, thrombocytopenia, and organ damage

Question 52

indications for red cell exchange

Answer 52

sickle cell, hereditary hemochromatosis, polycythemia vera, babesiosis, severe malaria

Question 53

most common use of red cell exchange

Answer 53

sickle cell patients experiencing acute crisis

Question 54

most common indication for leukapheresis

Answer 54

hyperviscosity in acute leukemia

Question 55

specialized procedure in which buffy coat layer of blood is collected from whole blood, treated with 8-methoxypsoralen, exposed to UV light, reinfused back into patient

Answer 55

photopheresis

Question 56

effect of photopheresis

Answer 56

causes crosslinking of leukocyte DNA preventing replication and induces apoptosis

Question 57

indications for photopheresis

Answer 57

``` cardiac allograft rejection lung allograft rejection cutaneous T-cell lymphoma GVHD systemic fibrosis pemphigus vulgaris scleroderma ```

Question 58

indications for selective adsorption apheresis

Answer 58

``` selective removal of LDL refractory rheumatoid arthritis polyneuropathies (IgG/IgA or IgM) lupus (removal of anti-DNA) myasthenia gravis ```

Question 59

reactions to therapeutic apheresis

Answer 59

tingling, hypotension, hives, nausea, shivering, flushing, fainting, vertigo, arrhythmia, abdominal pain, anaphylaxis

Question 60

most common adverse effect of apheresis

Answer 60

symptomatic hypocalcemia (perioral and digital paresthesias) from infusion of citrate with returned blood

Question 61

most common reaction with plasma replacement

Answer 61

allergic reactions