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20-September-2008 09:55:52 - Apheresis This article is about dialysis. For the lingustic term, see Apheresis linguistics. Whole blood enters the centrifuge on the left and separates into layers so that selected components can be drawn off on the right. Whole blood enters the centrifuge on the left and separates into layers so that selected components can be drawn off on the right. Apheresis Greek: to take away is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation. It is thus an extracorporeal therapy. Contents 1 Method 2 Types of apheresis 3 Uses 3.1 Donation 3.2 Therapy 4 See also 5 References 6 External links Method Depending on the substance that is being removed, different processes are employed in apheresis. If separation by weight is required, centrifugation is the most common method. Other methods involve absorption onto beads coated with an absorbent material and filtration. The centrifugation method can be divided into two basic categories: A. Continuous flow centrifugation CFC historically required two venipunctures as the continuous means the blood is collected, spun, and returned simultaneously. Newer systems can use a single venipuncture. The main advantage of this system is the low extracorporeal volume calculated by volume of the apheresis chamber, the donor's hematocrit, and total blood volume of the donor used in the procedure, which may be advantageous in the elderly and for children. B. Intermittent flow centrifugation works in cycles, taking blood, spinning/processing it and then giving back the unnecessary parts to the donor in a bolus. The main advantage is a single venipuncture site. To stop the blood from coagulating, anticoagulant is automatically mixed with the blood as it is pumped from the body into the apheresis machine. The centrifugation process itself has four variables that can be controlled to selectively remove desired components. The first is spin speed and bowl diameter, the second is sit time in centrifuge, the third is solutes added, and the fourth is not as easily controllable: plasma volume and cellular content of the donor. The end product in most cases is the classic sedimented blood sample with the RBC's at the bottom, the buffy coat of platelets and WBC's lymphocytes/granulocytes PMN's, basophils, eosinophils/monocytes in the middle and the plasma on top. It is important to remember that when the apheresis system is used for therapy the system is removing relatively small amounts of fluid not more than 10.5 mL/kg body weight. That fluid must be replaced to keep correct intravascular volume. The fluid replaced is different at different institutions. If a crystalloid like normal saline is used, the infusion amount should be triple what is removed as the three to one ratio of NS for plasma is needed to keep up oncotic pressure. Some institutions use normal serum albumin, but it is costly and can be difficult to find. Some advocate using FFP or a similar blood product, but there are dangers including citrate toxicity from the anticoagulant, ABO incompatibility, infection, and cellular antigens. Types of apheresis Disinfect, insert the cannula, pull out the cannula, dress the wound. The blue pressure cuff is controlled by the platelet apheresis machine in newer models. Disinfect, insert the cannula, pull out the cannula, dress the wound. The blue pressure cuff is controlled by the platelet apheresis machine in newer models. There are numerous types of apheresis. Blood taken from a healthy donor can be separated into its component parts, where the needed component is collected and the unused components are returned to the donor. Fluid replacement is usually not needed in these type of collections. There are large categories of component collections: Plasmapheresis - blood plasma. Plasmapheresis is useful in collecting FFP fresh frozen plasma of a particular ABO group. Commercial uses aside from FFP for this procedure include immune globulin products, plasma derivatives, and collection of rare WBC and RBC antibodies. Plateletpheresis thrombapheresis, thrombocytapheresis - blood platelets. Plateletpheresis, like it sounds, is the collection of platelets by apheresis; while returning the RBC's, WBC's, and component plasma. The yield is normally the equivalent of between six and ten random platelet concentrates. Quality control demands the platelets from apheresis be equal to or greater than 3.0 x 10^11 in number and have a pH of equal to or greater than 6.2 in 90% of the products tested and must be used within five days. ABO compatibility is a good idea. Leukapheresis - leukocytes white blood cells. Leukopheresis is the removal of PMN's, basophils, eosinophils for transfusion into patients whose PMN's are ineffective or traditional therapy has failed. There is limited data to suggest the benefit of granulocyte infusion. The complications of this procedure are the difficulty in collection and short shelf life 24 hours at 20 to 24 C. Since the buffy coat layer sits directly atop the RBC layer, HES, a sedimenting agent, is employed to improve yield while minimizing RBC collection. Quality control demands the resultant concentrate be 1.0 x 10^10 granulocytes in 75% of the units tested and that the product be irradiated to avoid graft-versus-host disease inactivate lymphocytes. Irradiation does not affect PMN function. Since there is usually a small amount of RBC's collected, ABO compatibility should be employed when feasible. Stem cell harvesting - circulating bone marrow cells are harvested to use in bone marrow transplantation. LDL apheresis - removal of low density lipoprotein in patients with familial hypercholesterolemia. Photopheresis Automated Red Cell Collection 2RBC - removal of two units of red blood cells. Erythrocytaphersis is the collection of RBC's, either two standard units of RBC's or one unit plus either plasma or platelets. The advantage to the donor is the use of smaller needles and saline compensation, as well as more convenient donating schedules the no-donation period following apheresis is twice as long as that for a single unit. The advantage to the blood bankers is the on-line separation into standardized RBC masses with the subsequent reduction in testing, data entry and staffing. This process is commonly referred to as 'Double Reds' or 'Double Red Cell Apheresis.'1 Immunoadsorbtion with Staphylococcal protein A-agarose column - removal of allo- and autoantibodies in autoimmune diseases, transplant rejection, hemophilia by directing plasma through protein A-agarose columns. Protein A is a cell wall component produced by several strains of Staphylococcus aureus which binds to the Fc region of IgG. Uses Donation Blood components can be separated from a collected bag of whole blood or from a donor's blood flow before collected to a blood bag. Various blood components are obtained by apheresis from donors. This includes platelets and blood plasma. Intravenous immunoglobulin IVIG is a blood product administered intravenously. It contains the pooled IgG immunoglobulins antibodies extracted from the plasma of thousands of blood donors. IVIG is given as a protein replacement therapy for immune deficient patients which have decreased or abolished antibody production capabilities. IVIG is administered to maintain adequate antibodies levels to prevent infections and confers a passive immunity. IVIG effects last between 2 weeks and 3 months. It is mainly used as treatment in three major categories: Immune deficiencies - Immune deficiencies such as X-linked agammaglobulinemia, hypogammaglobulinemia Primary immune deficiencies, and acquired compromised immunity conditions secondary immune deficiencies, featuring low antibody levels. Inflammatory and autoimmune diseases. Acute infections. Therapy The assembly A-D, operation E and disassembly F of the platelet apheresis machine which can be configured to separate other components as well. The assembly A-D, operation E and disassembly F of the platelet apheresis machine which can be configured to separate other components as well. Please refer to the individual apheresis methods for use in diseases The various apheresis techniques may be used whenever the removed constituent is causing severe symptoms of disease. Generally, apheresis has to be performed fairly often, and is an invasive process. It is therefore only employed if other means to control a particular disease have failed, or the symptoms are of such a nature that waiting for medication to become effective would cause suffering or risk of complications. See also Leukoreduction Venipuncture References ^ dtm double red cell External links 1 Apheresis News American Society for Apheresis WebPath Apheresis page. WebPath Blood Donation and Processing Donating Platelet Apheresis: Facts and the FAQ Baxter: Automated Component Collection Haemonetics: PCS2 System Haemonetics: MCS+ 9000 Dystem Gambro BCT: Trima Automated Blood Collection System Gambro BCT: COBE Spectra Apheresis System Gambro BCT: Spectra Optia Apheresis System v d e Transfusion medicine General concepts Apheresis Plasmapheresis, Plateletpheresis, Leukapheresis - Blood transfusion - Coombs test - Cross-matching - Exchange transfusion - International Society of Blood Transfusion - Intraoperative blood salvage - ISBT 128 - Transfusion reactions Human blood group systems - Blood type ABO - Chido-Rodgers - Colton - Cromer - Diego - Dombrock - Duffy - Gerbich - GIL - Hh - Ii - Indian - JMH - Kell Xk - Kidd - Knops - LW - Lewis - Lutheran - MNS - OK - P - Raph - Rh - Scianna - T-Tn - Xg - Yt - Other Blood products Blood donation - Blood substitutes - Cryoprecipitate - Platelets - Plasma - Red blood cells - Whole blood Retrieved from http://en..org/wiki/Apheresis Categories: Hematology | Medical treatments | Transfusion medicine Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Dansk Deutsch Þ‹Þ¨ÞˆÞ¬Þ€Þ¨Þ„Þ¦Þ?Þ° Español Français Interlingua Italiano Polski Srpskohrvatski / СрпÑ?кохрватÑ?ки This page was last modified on 29 June 2008, at 20:53
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