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Encyclopedia > Plasmapheresis

Plasmapheresis (from the Greek plasma, something molded, and apheresis, taking away) is the removal, treatment, and return of (components of) blood plasma from blood circulation. It is thus an extracorporeal therapy. The method can also be used to collect plasma for further manufacturing into a variety of medications. Image File history File links Question_book-3. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... For transport in plants, see Vascular tissue. ... An extracorporeal medical procedure is a medical procedure which is carried outside the body. ...

Contents

As therapy

During plasmapheresis, blood is initially taken out of the body through a needle or previously implanted catheter. Plasma is then removed from the blood by a cell separator. Three procedures are commonly used to separate the plasma from the blood: Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ...

Discontinuous flow centrifugation
One venous catheter line is required. Typically, a 300 ml batch 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 as it is able to continuously spin out plasma.
Plasma filtration
Two venous lines are used. The plasma is filtered using standard hemodialysis equipment. This continuous process requires less than 100 ml of blood to be outside the body at one time.

Each method has its advantages and disadvantages. After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma, which contains the antibodies, is first treated and then returned to the patient in traditional plasmapheresis. (In plasma exchange, the removed plasma is discarded and the patient receives replacement donor plasma or saline with added proteins.) Medication to keep the blood from clotting (an anticoagulant) is generally given to the patient during the procedure. Plasmapheresis is used as a therapy in particular diseases. It is an uncommon treatment in the United States, but it is more popular in Europe and particularly Japan.[citation needed] Look up filtration in Wiktionary, the free dictionary. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Blood transfusion is the process of transferring blood or blood-based products from one person into the circulatory system of another. ... This article is about the medical term. ... For other uses, see Europe (disambiguation). ...


An important use of plasmapheresis is in the therapy of autoimmune disorders, where the rapid removal of disease-causing autoantibodies from the circulation is required in addition to slower medical therapy. It is important to note that plasma exchange therapy in and of itself is useful to temper the disease process, where simultaneous medical and imunosuppressive therapy is required for long term management. Plasma exchange offers the quickest short-term answer to removing harmful autoantibodies; however, the production of autoantibodies by the immune system must also be stopped, usually by the use of medications that suppress the immune system, such as prednisone, cyclophosphamide, cyclosporine, mycophenilate mofetil, and/or rituximab. Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... An autoantibody is an antibody (a type of protein) manufactured by the immune system that is directed against one or more of the individuals own proteins. ... Rituximab, sold under the trade names Rituxan® and MabThera®, is a monoclonal antibody used in the treatment of B cell non-Hodgkins lymphoma, B cell leukemia, and some autoimmune disorders. ...


Other uses are the removal of blood proteins where these are overly abundant and cause hyperviscosity syndrome. Hyperviscosity syndrome is an increase in the viscosity of the blood. ...


Examples of diseases that can be treated with plasmapheresis:

Guillain-Barré syndrome (GBS) (IPA pronunciation: is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. ... Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired immune-mediated inflammatory disorder of the peripheral nervous system but often can have central nervous system involvement. ... Goodpasture’s syndrome (also known as Goodpasture’s disease and anti-glomerular basement membrane disease or anti-GBM disease) was first described by Ernest Goodpasture in 1919. ... Hyperviscosity syndrome is an increase in the viscosity of the blood. ... Cryoglobulinemia is the presence of abnormal proteins in the bloodstream which thicken or gel on exposure to cold. ... Paraproteinemia (or Paraproteinaemia) is the presence of a monoclonal gammopathy in the blood. ... Waldenström macroglobulinemia (WM) is cancer involving a subtype of white blood cells called lymphocytes. ... Myasthenia gravis (sometimes abbreviated MG; from the Greek myastheneia, lit. ... Thrombotic thrombocytopenic purpura (TTP or Moschcowitz disease) is a rare disorder of the blood coagulation system. ... In medicine, Hemolytic-uremic syndrome (or haemolytic-uraemic syndrome, abbreviated HUS) is a disease characterised by microangiopathic hemolytic anemia, acute renal failure and a low platelet count (thrombopenia). ... In medicine (rheumatology), Wegeners granulomatosis is a form of vasculitis that affects the lungs, kidneys and other organs. ... Lambert-Eaton myasthenic syndrome (LEMS) is a rare disorder of nerve-muscle (neuromuscular) junction. ... Antiphospholipid Antibody Syndrome (APS) is the disease in which the presence of antiphospholipid antibodies is found in patients with arterial or venous thrombosis or pregnancy morbidity. ... Microscopic polyangiitis (MPA) is an ill-defined autoimmune disease characterized by pauci-immune, necrotizing, small-vessel vasculitis without clinical or pathological evidence of necrotizing granulomatous inflammation. ... Focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome in children and adolescents, as well as an important cause of kidney failure in adults. ...

Complications of plasmapharesis therapy

Though plasmapharesis is helpful in certain medical conditions, like any other therapy, there are potential risks and complications. Insertion of a rather large intravenous catheter can lead to bleeding, lung puncture (depending on the site of catheter insertion), and, if the catheter is left in too long, it can get infected.


Aside from placing the catheter, the procedure itself has complications. When blood is outside of the body, while it is passing through the plasmapharesis filter, blood has a tendency to clot. To reduce this tendency, citrate is infused while the blood is running through the circuit. Citrate binds to calcium in the blood; calcium is essential for blood to clot. While citrate is very effective in preventing blood from clotting; however, its use can lead to life-threatening low calcium levels. To prevent this complication, calcium is infused intravenously while the patient is undergoing the plasmapharesis; in addition, calcium supplementation by mouth may also be given.


A second common complication of the plasmapharesis procedure is the potential exposure to blood products


A third complication is suppression of the patient's immune system


A fourth complication is bleeding.


As manufacturing process

Plasma donation is in many ways similar to whole-blood donation, though the end product is used for different purposes. Almost all plasmapheresis in the US is performed by automated apheresis machines. Whole blood enters the centrifuge on the left and separates into layers so that selected components can be drawn off on the right. ...

Manual method
For the manual method, approximately the same as a blood donation is collected from the donor. The collected blood is then centrifuged by centrifuge machines in separate rooms, the plasma is pressed out of the collection set into a satellite container, and the red blood cells are returned to the donor. Since returning red cells causes the plasma to be replaced more rapidly by the body, a donor can provide up to a liter of plasma at a time and can donate with only a few days between donations, unlike the 56-day deferral for whole blood donation. The amount allowed in a donation varies vastly from country to country, but generally does not exceed two donations, each as much as a liter, per 7-day period.

The theoretic danger with this method was that if the wrong red blood cells are returned to the donor, a serious and potentially fatal transfusion reaction would occur. Requiring donors to recite their names and ID numbers on returned bags of red cells eliminated this risk. Give blood redirects here. ... Transfusion reactions occur after blood product transfusions when there is an interaction between the recipient and the donor blood. ...

Automated method
The automated method uses almost exactly the same process except that the collection, separation, and return are all performed inside a machine which is connected to the donor and there is no risk of receiving the wrong red cells.[1] The devices used are very similar to the devices used for therapeutic plasmapheresis.

If a significant amount of red blood cells cannot be returned, the donor may not donate for 56 days, just as if they had donated a unit of blood.


The collected plasma is promptly frozen at lower than -20 degrees C and is typically shipped to a processing facility for fractionation. This process separates the collected plasma into specific components, such as albumin and immunoglobulins, most of which are made into medications for human use. Sometimes the plasma is thawed and transfused as Fresh Frozen Plasma (FFP), much like the plasma from a normal blood donation. Albumin can refer to ovalbumin, the principal protein in egg white albumins, a group of proteins including serum albumin and together constituting roughly 60% of the protein in blood plasma. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ...


Donors are sometimes immunized against agents such as Tetanus or Hepatitis B so that their plasma contains the antibodies against the toxin or disease. The collected plasma then contains these components, which are used in treating the diseases in question. Donors who are already ill may have their plasma collected for use as a positive control for laboratory testing. Tetanus is a medical condition that is characterized by a prolonged contraction of skeletal muscle fibers. ... “HBV” redirects here. ...


Plasma donors are typically paid cash for their donations. Since the products are heavily processed and treated to remove infectious agents, the higher risk is considered acceptable. Standards for plasma donation are set by national regulatory agencies such as the FDA[2] and by a professional organization, the Plasma Protein Therapeutics Association or PPTA[1], which audits and accredits collection facilities. A National Donor Deferral Registry (NDDR) is also maintained by the PPTA for use in keeping donors with prior positive test results from donating. The plasmapheresis industry, however, has been accused of lax donor requirements and practices, i.e., facilities in rundown neighborhoods and entire cities already having large numbers of high-risk potential donors. Some action has been taken by the industry to correct these issues and change this image. The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ... A city is an urban area, differentiated from a town, village, or hamlet by size, population density, importance, or legal status. ...


References

External links


  Results from FactBites:
 
Plasmapheresis - Wikipedia, the free encyclopedia (499 words)
Plasmapheresis is the removal of (components of) blood plasma from the circulation.
It is used as a therapy in particular diseases, and it is also a method by which blood donors donate only plasma, with remaining red cells and platelets returned to their circulatory systems, allowing up to twice weekly plasma donations.
An important use of plasmapheresis is in the therapy of autoimmune disorders, where the symptoms are so catastrophic that medical therapy is insufficient in controlling the symptoms.
  More results at FactBites »

 
 

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