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Flashcards in Therapeutic apheresis Deck (5)
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1

Categories of therapeutic apheresis

  1. Category I
    • marked leukocytosis with leukostasis (cytapheresis)
    • SCD, acute stroke
    • apheresis is standard and acceptable as a primary therapy or firstline adjunct therapy
    • is not mandatory in all cases
  2. Category II
    • SCD, acute chest, stroke prophylaxis or prevention of iron overload
    • thrombocytosis, symptomatic
    • apheresis is generally accepted but considered tobe supportive or adjunctive to other treatments rather than a first line treatment
  3. Category III
    • Heart transplantation antibody mediated rejection, acute hepatic failure, posttransfusion purpura, chronic progressive MS
    • apheresis may be beneficial, however there is insufficient evidence to establish the efficacy or to clarify the risk or benefit
  4. Category IV
    • ITP, HUS, SLE nephritis
    • Controlled trials have not shown benefit, or anecdotal reports have been discouraging
    • apheresis for these disorders should be carried out only in the context of an IRB approved research protocol

2

Category I apheresis indications

  1. marked leukocytosis
  2. SCD, acute stroke
  3. Acute inflammatory demyelinating polyneuropathy (Guillain-Barre)
  4. ANCA associated rapidly progressive GN
  5. Antiglomular basement membrane disease (Goodpasture)
  6. CIDP
  7. Cryoglobulinemia: severe or symptomatic
  8. FSGS, recurrent
  9. Hyperviscosity 2/2 monoclonal gammopathy (especially IgM)
  10. MG
  11. Paraproteinemic polyneuropathies
  12. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and Sydenham chorea
  13. Renal transplantation, antibody mediated rejection
  14. TTP

3

Category II apheresis indications

  1. SCD, acute chest, stroke prophylaxis or prevention of iron overload
  2. symptomatic thrombocytosis
  3. SLE: cerebritis, diffuse alveolar hemorrhage
  4. Renal transplantation: HLA desensitization or ABO incompatible transplant
  5. Catastrophic antiphospholipid syndrome
  6. chronic focal encephalitis (Rasmussen encephalitis)
  7. MS: acute CNS inflammatory demyelinating disease refractory to steroids
  8. Mushroom poisoning
  9. Phytanic acid storage disease (Refsum disease)
  10. Neuromyelitis optica (Devic syndrome)

4

apheresis replacement fluids

  • normal saline
  • 5% albumin
  • allogeneic plasma (FFP or cryo poor FFP) in TTP

5

Medication interactions with apheresis

  • highly protein bound meds or meds with low volume of distribution (vd<0.2 L/kg) may be removed
  • dosing immediately after apheresis should be considered
  • ACE inhibitors should be d/c'd 24 hours prior to apheresis since they can cause hypotension