Plasmapheresis
Plasmapheresis | |
---|---|
ICD-10-PCS | 6A5 |
ICD-9-CM | 99.7 |
MeSH | D010956 |
Plasmapheresis (from the
Three general types of plasmapheresis can be distinguished:
- Autologuous, removing blood plasma, treating it in some way, and returning it to the same person, as a therapy.
- Exchange, a patient's blood plasma is removed, while blood products are given in replacement. This type is called plasma exchange (PE, PLEX, or PEX) or plasma exchange therapy (PET). The removed plasma is discarded and the patient receives replacement donor plasma, albumin, or a combination of albumin and saline (usually 70% albumin and 30% saline).
- Donation, removing blood plasma, separating its components, and returning some of them to the same person, while holding out others to become blood products that this person donates for those in need. In such a plasma donation procedure, blood is removed from the body, blood cells and plasma are separated, and the blood cells are returned, while the plasma is collected and frozen to preserve it for eventual use as fresh frozen plasma or as an ingredient in the manufacture of blood products.[1]
Plasmapheresis of the autologous and exchange types is used to treat a variety of disorders, including those of the
Medical uses
During plasmapheresis, blood, which consists of blood cells and a clear liquid called blood plasma, 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 cells, with each method having its own advantages and disadvantages:[citation needed]
- 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 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 that less than 100 ml of blood be outside the body at one time.
After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma, which contains the
Plasmapheresis is used as a therapy in particular diseases. It is an uncommon treatment in the United States, but it is more common in Europe and particularly Japan.[5]
An important use of plasmapheresis is in the therapy of
]Other uses are the removal of blood
There is weak evidence that therapeutic plasma exchange (TPE) might be of benefit in severe cases of COVID-19.[6]
Examples of diseases that have been treated with plasmapheresis
- Acute disseminated encephalomyelitis (ADEM)
- Antiphospholipid antibody syndrome(APS or APLS)
- Behcet syndrome
- Chronic inflammatory demyelinating polyneuropathy
- Goodpasture's syndrome
- Granulomatosis with polyangiitis
- Graves' disease in infants and neonates
- Guillain–Barré syndrome
- HELLP syndrome
- neuropathy[7]
- Hyperviscosity syndromes:
- Cryoglobulinemia
- Paraproteinemia
- Waldenström macroglobulinemia
- Idiopathic pulmonary fibrosis
- Lambert-Eaton syndrome
- Microscopic polyangiitis
- Miller Fisher syndrome[8]
- Multiple sclerosis
- Myasthenia gravis
- Neuromyelitis optica
- Opsoclonus myoclonus syndrome
- PANDAS syndrome (experimental, unproven)[9][10]
- Pemphigus vulgaris
- Recurrent focal and segmental glomerulosclerosis in the transplanted kidney
- Refsum disease
- Rhabdomyolysis
- Systemic sclerosis (scleroderma)[11]
- hemolytic uremic syndrome
- Toxic epidermal necrolysis (TEN)
- Transverse myelitis
Complications of plasmapheresis therapy
Though plasmapheresis is helpful in certain medical conditions, like any other therapy, there are potential risks and complications. Insertion of a rather large
Aside from placing the catheter, the procedure itself has complications. When patient blood is outside of the body passing through the plasmapheresis machine, the blood has a tendency to clot. To reduce this tendency, in one common protocol,[
Other complications include:
- Bleeding or hematoma from needle placement
- Hypotension
- Potential exposure to blood products, with risk of transfusion reactionsor transfusion transmitted diseases
- Suppression of the patient's immune system
Plasma donation
Donating plasma is similar in many ways to
Plasma donors undergo a screening process to ensure both the donor's safety and the safety of the collected product. Factors monitored include
In a few countries, plasma (like blood) is donated by unpaid volunteers. In others, including the United States, Austria, Germany and some Canadian facilities plasma donors are paid for their donations.
Almost all plasmapheresis in the US is performed by automated methods.[15] In some cases, automated plasmapheresis is used to collect plasma products like fresh frozen plasma for direct transfusion purposes, often at the same time as plateletpheresis. These procedures are performed at facilities such as community blood centers.[16]
Since returning
The collected plasma is promptly frozen at lower than -20 °C (-4 °F) and is typically shipped to a processing facility for fractionation. This process separates the collected plasma into specific components, such as
- Manual method
- For the manual method, approximately the same as a whole blood donation is collected from the donor. The collected blood is then separated 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.
- The danger with this method was that if the wrong red blood cells were returned to the donor, a serious and potentially fatal transfusion reactioncould occur. Requiring donors to recite their names and ID numbers on returned bags of red cells minimized this risk. This procedure has largely become obsolete in favor of the automated method.
- Automated method
- The automated method uses a very similar process. The difference is that the collection, separation, and return are all performed inside a machine connected to the donor through a needle in the arm, typically the antecubital vein. There is no risk of receiving the wrong red cells.[17] The devices used are very similar to the devices used for therapeutic plasmapheresis, and the potential for citrate toxicity is similar. The potential risks are explained to prospective donors at the first donation, and most donors tolerate the procedure well.[18] In the UK in 2020, plasma donation is sought from volunteers who have recovered from COVID-19. The process takes 560 ml (two units) of plasma in five or six consecutive cycles of about 100 ml per cycle over a period of approximately an hour.[citation needed]
- Antibodies
- Donors are sometimes immunized against agents such as tetanus or hepatitis B so that their plasma contains the antibodies against the toxin or disease. In other donors, an intentionally incompatible unit of blood is transfused to produce antibodies to the antigens on the red cells. The collected plasma then contains these components, which are used in manufacturing of medications. Donors who are already ill may have their plasma collected for use as a positive control for laboratory testing.[citation needed]
History
Plasmapheresis was originally described by doctors Vadim A. Yurevick and Nicolay Rosenberg of the Imperial Medical and Surgical Academy of Saint Petersburg in 1913.[19] and John Abel and Leonard Rowntree of Johns Hopkins Hospital in 1914.[20] Both studies carried out on animals, are considered precedent to subsequent studies held in humans and offered the first description of the technique. The first studies of the effects of plasmapheresis on humans were undertaken during the WWII period, and the results were reported in a study over six plasma donors presented by doctors Co Tui, F.C. Bartter and A.M. Wright in 1944.[21]
Aware of the rising demand for plasma for transfusion, Dr.
At the Lisbon congress, Grifols-Lucas met Edwin Cohn. While Grifols-Lucas was presenting a safe technique for obtaining large quantities of plasma from healthy donors, Cohn presented a plasma fractionator, a device that separated out the proteins contained in plasma. These two major contributions marked the birth of a new industry: plasma fractionation to obtain plasma products.[24] In 1955, further data were presented at the 5th Congress of the European Hematology Society, in Freiburg, Germany, based on the ongoing performance of plasmapheresis over a five-year period. In 1956 Grifols-Lucas presented the results at the 6th Congress of the International Hematology Society in Boston, US.[24]
Michael Rubinstein was the first to use plasmapheresis to treat an immune-related disorder when he saved the life of an adolescent boy with
In 1965, Dr. Víctor Grifols-Lucas, brother of Josep Antoni Grifols-Lucas, patented the device, along with the procedure for performing plasmapheresis in situ,[26] that is, with the donor present. This replaced a fragmented, manual process with a continuous automatic method which enabled blood components to be extracted, separated and returned to the donor in a single procedure. The new device made plasmapheresis faster and simpler, and also made it safer for donors.[citation needed]
See also
References
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- ^ MedlinePlus. "Goodpasture syndrome". U.S. National Library of Medicine. Retrieved 7 April 2013.
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- ^ Kiprov D.D., Stricker R.B., Miller R.G. Int. Conf. AIDS. 1992 Jul 19-24; 8: 95 (abstract no. PuB 7281). U.S. Nat'l Institutes of Health, NLM Gateway[permanent dead link]. Abstract retrieved 8-22-2009.
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- ^ "One Day, Two Dollars". September 1, 2015.
- ^ "CFR - Code of Federal Regulations Title 21". www.accessdata.fda.gov.
- ^ Plasma Protein Therapeutics Association. PPTA [Online].
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- ^ "Therapeutic Apheresis Services | New York Blood Center". nybloodcenter.org. Archived from the original on 2020-07-17. Retrieved 2020-07-04.
- ^ "BioLife Plasma Services". www.biolifeplasma.com. Archived from the original on August 22, 2007.
- ^ "Donate Plasma. Make Money. Save Lives. | Octapharma Plasma". octapharmaplasma.com.
- ^ Yurevick, V.A.; Rosenberg, N. (1913). "For the Question Regarding Washing of Blood Outside of the Body and the Vitality of Red Blood Cells". Russki Vratch. 18.
- ^ Abel, J.J.; Rowntree, L.G.; Turner, B.B. (1914). "On the removal of diffusible substances from the circulating blood by means of dialysis". J Pharmacol Exp Ther. 5: 275–316.
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- ^ Grífols-Lucas, J.A. (1952). "Primeras aplicaciones de la plasmaféresis en el hombre". Medicina Clínica. 18 (4): 301–2.
- ^ ISBN 978-84-697-1739-4.
- ^ a b Wallace, D.J. "Apheresis for lupus erythematosus". Lupus (1999) 8, 174–80.
- ^ ES application 309216 V. Grifols Lucas: "Aparato para practicar, in situ, la plasmaféresis". Madrid: Oficina Española de Patentes. Filing date 1965