Académique Documents
Professionnel Documents
Culture Documents
Definition
centrifuge
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Plasmapheresis
Preparative Plasmapheresis
Therapeutic Plasmapheresis
16.02.04
Blood Cells
selective
Plasma Fractions
semi-selective
Conserved Plasma
non-selective
Dr. M. Susca
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Overview
Plasmapheresis
Preparative Plasmapheresis
Conserved Plasma
Plasma Fractions
Therapeutic Plasmapheresis
Blood cells
non-selective
semi-selective
selective
Coagulation Factors
Leucocyte Concentrates
Cascade Filtration
Fresh-frozen-Plasma (FFP)
Human Albumine
Erythrocyte Concentrate
Cryo Filtration
Immuno Adsorption
Thrombocyte Concentrate
Immuno Adsorption
Phenylalanin
Tryptophan
Protein A
LDL-Apheresis
Heparin Prezipitation
Dextransulfat Adsorption
Immuno Adsorption
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Therapeutic Plasmapheresis
non-selective
semi-selective
selective
Cascade Filtration
Cryo-Filtration
Immuno-Adsorption
Immuno-Adsorption
Protein A
Phenylalanin
Tryptophan
LDL-Apheresis
Heparin Prezipitation
Dextransulfat Adsorption
Immuno-Adsorption
Thermo-Filtration (?)
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Cryo-Filtration
Dextransulfat Adsorption
Cascade Filtration
Therapeutic Heparin Precipitation
Immuno-Adsorption
Plasma Exchange
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16.02.04
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Hemocompatibility
Sterilisation:
ETO
Steam
Gamma
Secondary Membrane
Material:
Polypropylen
Polysulfon
Cellulosediacetat
Cut-off 3 MioDa
Sieving Coefficient >0.8
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Thrombocytes 2-3.5 m
Albumine 69 kDa
IgG 150 kDa
IgA 160 kDa
IgM 900 kDa
0.02 m
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Sieving Coefficient
Plasma Component
Total Protein
Albumine
IgG
IgA
IgM
Fibrinogen
Cholesterol
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Sieving Coefficient
0.9
0.95
0.9
0.85
0.8
0.95
0.8
Dr. M. Susca
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16.02.04
Dr. M. Susca
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PPL
BLD
SAC
Heparin
V
V
PA
Plasma Filter
SAD
Advantages
Disadvantages
non-selective
substitution
complications
no chronic
application
16.02.04
Pl.
Balance
Dr. M. Susca
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Blood Access
Vessel Access
periferal vein
arterio-venous fistula
central-venous access
V. jugularis
interna
V.
subclavia
V.
cubitalis
V.
femoralis
Cimino Fistula
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Anticoagulation
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Dr. M. Susca
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Coagulation Cascade
Defect
Injury
Tissue
Endothel
Exogen System
Endogen System
XII
XI
IX
XIIa
XIa
IXa
VIII
Ca (IV)
TF3
Citrate
2+
TF3
+
Thrombocytes
XIII
Thrombin
Xa + V + Ca2+
(IV)
Prothrombin (II)
Heparin
AT III
Fibrin Monmers
Fibrinogen (I)
XIIIa
Fibrin
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Dr. M. Susca
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Substitution
Clinical
Requirement
isovolemic, isotonic, isooncotic
allergen and pyrogen free, sterile
containing coagulation
factors and
immunoglobulins
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Dr. M. Susca
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Substitution
Remarcs
1. Plasma Expander
2. Conserved Plasma
Protein
3. Fresh Frozen Plasma
(FFP)
4. Human Albumine
Solution
16.02.04
AB0-Compatibility,
Indikation for TTP und Goodpasture-Syndrom,
Dr. M. Susca
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Hemofiltration Solution
Na+
mmol/l
K+
mmol/l
Ca2+
mmol/l
Mg2+
mmol/l
Clmmol/l
Lactate
mmol/l
Glucose
g/l
Osmol.
mmol/l
135-150
0-4
1.6-2.0
0.50-0.75
100-113
35-45
0-2.0
285-312
Na+
mmol/l
K+
mmol/l
Ca2+
mmol/l
Mg2+
mmol/l
Clmmol/l
Bicarbon.
mmol/l
Glucose
g/l
Osmol.
mmol/l
140
0-4
1.5
0.5
109-113
35
1.0
290-300
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3%
3.5%
4%
4.5%
5%
5.5%
6%
Solution Solution Solution Solution Solution Solution Solution
HF-Solution (ml)
850
825
800
775
750
725
700
150
175
200
225
250
275
300
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Albumine Solution
HF Solution
Albumine
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Dr. M. Susca
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Exchange Volume
Plasma Volume - 2 PV
Ratio
1:1
Therapy Time 1 3 h
acute: 1x
day for 3 days lang, then every 2 days
Frequency
chronic: 1-4 monthly
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Dilution Kinetics
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Distribution Volume
Normal value
g/l
Albumine
69 000
40
19
35-50
IgG
150 000
50
20-23
8-18
IgA
160 000
50
5-6
0.9-4.5
IgM
900 000
80
5-6
0.6-2.8
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Complications
technical
medical
Access Problems
Hypotension
Allergy
Blood Leak
Fever
Hemolysis
Hypocalcemia
Arrhythmia
Edema
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Indications
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Dr. M. Susca
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Remind
1. Plasmapheresis is often a symptomatic
therapy
2. Plasmapheresis can cause a ReboundEffect by resynthesis and
redistribution of pathogens
3. Therefore plasmapheresis is regulary
accompanied by an immunosuppressive or cytostatic therapy
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Cascade Filtration
Heater
PV
PPL
BLD
Heparin
V
V
PA
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Cascade Filter
SAC
Plasma Filter
SAD
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Cascade Filtration
(DeadEnd-Procedure)
Heater
PV
PPL
BLD
Heparin
V
V
PA
Cascade Filter
SAC
Plasma Filter
SAD
Retinate Pump
Retinate Bag
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Cascade Filtration
(Recirculation-Procedure)
Heater
PV
PPL
BLD
Heparin
V
V
Cascade Filter
SAC
Plasma Filter
SAD
PA
Recirculation
Pump
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Thermofiltration
PV
PPL
BLD
SAC
PA
Cascade Filter
Heparin
Plasma Filter
SAD
Heater
Retinate Pump
Retinate Bag
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PPL
BLD
Heparin
V
V
PA
Particle Filter
16.02.04
Dr. M. Susca
Plasma Adsorber
SAC
Plasma Filter
SAD
33/34
PPL
Regeneration
Solution
BLD
SAC
Heparin
V
V
PA
Plasma Filter
SAD
Plasma
Adsorber
Particle Filter
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Dr. M. Susca
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