1.

Removal of whole blood from a donor or a patient Separation into blood components

2.

3.

Retention of desired component

Return of the remaining elements to the donor or patient Can be used to collect a component intended for transfusion or remove a pathologic component

4.

5.

Centrifugation Types of separation Membrane Filtration

Continuous Process Types of Machines Intermittent Process

ACD

Desired component

Inlet Pump

Plasma Pump

Return to Patient

Platelets
1.048*

Lymphocytes

Plasma
Buffy coat

1.071*

Monocytes
1.065*

Packed red cells

Granulocytes
1.085*

DONOR APHERESIS

APHERESIS
THERAPUTIC PLASMA EXCHANGE

Red cell pheresis Plateletpheresis

Plasmapheresis
Granulocytopheresis Stem cell pheresis

Collecting only packed red cells from the donor Up to 2 units of red cells can be collected from a single donor Interval between 2 units donation is 6 months

Desired Hb% 14 gms, weight > 60 Kgs

Useful in corporate setups where finding donors is difficult

Plateletpheresis is the process of collecting only platelets Random donor Platelets > 5.5 x 1010 platelets in 50 - 70 ml of plasma 3 x 1011 platelets in ~ 300 ml of plasma

Single Donor platelet

High quality product with better post transfusion platelet increments

Leuko-Reduced product Reduced donor exposure therefore reduced TTIs and Alloimmunization Less time consuming and can be harvested from a single donor Donor can donate 2 times a week Single unit transfusion increases post transfusion 30 40 thousand

Severe neutropenia (ANC <0.5 x 109/L1) due to congenital or acquired bone marrow failure syndromes. On active chemotherapy in an attempt to achieve disease remission. Proven or highly probable fungal or bacterial infection that is unresponsive to appropriate antimicrobial therapy (demonstrated by visible spreading lesions on skin, mucosa or radiological examination) Congenital disorder of neutrophil function regardless of neutrophil count

Patients with bone marrow failure where neutrophil recovery is not anticipated to recur spontaneously and no further active treatment is planned
Sepsis in the absence of either neutropenia or known neutrophil dysfunction

Pyrexia of unknown origin (PUO)

Granulocytes are transfused daily until the patient's infection clears or until the neutrophil count exceeds 500/l
Dosage: 1x 1010

Process of harvesting circulating blood stem cells to use in bone marrow transplantation. Can also be collected and separated from the bone marrow Stem cell marker is CD 34 Minimum dosage 2x106 per kg body weight of the patient

Aplastic anemia Sickle cell anemia, thalassemia Fanconis anemia, Pure red cell aplasia Congenital immune deficiency syndromes Glycogen and lipid storage disorders PNH, Radiation injury Leukemia's Lymphomas

Erythrocytopheresis
Thrombocytopheresis Leukopheresis

o LDL Pheresis

o Immuno Adsorption

o Photopheresis

Plasmapheresis

Sickle Cell Dis. Malaria

Thrombocytosis

RBC

WBC

PLT

Plasma

Leukemias Cell Therapies

Guillain Barrie Synd. Myasthenia Gravis Good pastures Synd. Acute liver failure Drugs overdose Poisoning

 Extracorporeal

blood purification technique designed to remove large molecular weight substances from the plasma.
pathogenic auto antibodies, immune complexes, cryoglobulins, myeloma light chains, endotoxin, and cholesterol containing lipoproteins.

Examples:

The substance to be removed should be

Sufficiently large (mol wt greater than 15,000) which cannot be easily removed by less expensive purification techniques like hemofiltration or high-flux hemodialysis. Must have a sufficiently long half-life, so that extracorporeal removal is much more rapid than endogenous clearance pathways. Must be acutely toxic and resistant to conventional therapy, so that the rapid elimination from the extracellular fluid by TPE is indicated.

Plasma Volume Exchange 0 0.5 1.0 1.5

Percent Removed 0% 39.3% 63.2% 77.7%

2.0 2.5
3.0

86.5% 91.8%
95.0%

Efficiency of removal is greatest early in the procedure and diminishes progressively during the exchange.

Category I: Standard acceptable first line therapy

Category II: Generally accepted in a supportive role

Category III: Not clearly indicated based on insufficient evidence. Category IV: Demonstrated to have a lack of efficacy Clinical applications should be undertaken only under an approved research protocol.

Neurological: Guillain Barre synd Myasthenia Gravis CIDP Paraprotein associated poly neuropathy Hematological: TTP Sickle cell crisis ABO mismatch Marrow transplant

Others:

Cutaneous T cell Lymphoma Leukocytosis Thrombocytosis Good pasteur synd Hypercholestrolemia Phytanic acid storage disease Amanita phalloides poisoning Cryoglobinemia

Neurological: Multiple sclerosis Renal & Others: Eaton lambert synd Acute CNS inflamatory demyelinating disease RPGN Pediatric autoimmune Acute renal failure due neropsychiatry disorder to cast nephropathy Hematological: ITP Maternal-fetal Rh incompatability Coagulation factors inhibitors Hyperviscosity synd

Graves disease Digitalis toxicity Pemphigus vulgaris Bullous pemphigoid Toxic epidermonecrolysis

Neurological: Stiff man syndrome Multiple sclerosis Paraneoplastic synd Polymyositis Hematological:

Posttransfusion Purpura
Aplastic anemia Autoimmune hemolytic anemia

Renal & others: Hepatic failure Recurrent focal glomrulosclerosis HUS Renal transplant rejection Heart transplant rejection Drugs over dose Poisoning

Examples: AIDS, amyotrophic lateral sclerosis, lupus nephritis, psoriasis, renal transplant rejection, schizophrenia, rheumatoid arthritis

Acute progressive paralyzing illness affecting both motor and sensory peripheral nerves . Etiopathology: Ab to Basic Myelin protein which causes destruction of myelin (Demyelination). Clinical features: Rapidly progressive symmetrical muscle weakness, and paresthesias, respiratory and oropharyngeal muscles may involve in more severe cases requiring mechanical ventilation Autonomic dysfunction (BP & HR) seen in 25% of patients. long-term neurologic deficits in 75%. Mortality 5%.

Most effective when initiated within 7 days of disease onset. Can accelerate motor recovery, decrease time on the ventilator, and speed attainment of other clinical milestones. Median time to wean from mechanical ventilation and the time to walk without assistance are comparable or sometimes better than IV IG Patients with axonal involvement reported greater potential benefit than IVIG

Nerve Acetylcholine (Ach) Anti-AchR Ab AchR

Muscle

Auto-Ab directed against the acetylcholine receptors on the motor end plate prevents the normal functioning of the receptors by increasing the receptor turnover, blocking the binding of acetylcholine, and fixing complement with degradation of the receptor.

Acetylcholine esterase inhibitors : Increases the amount of acetycholine at the motor end plate eg., pyridostigmine ,neostigmine 2) Immuno-suppressive medications : Decreases the antibody production eg., cortico-steroids or azathioprine. 3) IVIg give beneficial effects.
1)

4)TPE: is specially useful during1) crisis and 2) Before thymectomy for early recovery from surgery 3) Management of severe disease refractory cases unresponsive to conventional therapy 4) Rapid resolution of clinical signs, 5) Lower incidence of complications

Causes: Hepatitis ( viral, autoimmune) Drug toxicity ( Acetaminophen) Ingestion of hepatotoxins Wilsons disease Fulminant liver failure: Mortality rate is 50 90 % caused by acute metabolic disturbances, hepatic encephalopathy, severe coagulopathy

Removes albumin bound and large mol.wt toxins like aromatic amino acids, endotoxins, indols, mercaptan , phenol

Most studies show improved cerebral & hepatic blood flow, mean arterial pressure, cerebral perfusion pressure and cerebral metabolic rate
Improves laboratory parameters cholinesterase activity & galactose activity

Restores coagulation factors and removes activated clotting factors, tissue plasminogen activator, FDP
In some patients, liver regenerates during TPE

Mushroom ( Amanita phyllode) Paraquat Anti digoxin antibodies Vincristine Eltroxin

Tricyclic anti-depressants Methanol Ethanol Heavy metal ( mercury ) Verapamil

Cysplatin.
Carbamazepine

Diltiazem,

Drug removal is most dependent on percentage of protein binding and volume of distribution. Drugs with a high percentage of protein binding and a relatively modest volume of distribution will have the greatest likelihood of being removed by TPE

Not significantly removed: Prednisolone

Minimal removal: Cyclophosphamide Azathioprine Aminoglycosides Tobramycin Digoxin Vancomycin

Post treatment supplement needed: Phenytoin Acetylsalicylic acid Propranolol Thyroxine

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