Plasmapheresis (plasma exchange) is the removal of blood plasma to purify it of unwanted particles. The patient receives blood either with his own purified plasma, or the plasma is replaced with replenishing fluid. When is plasmapheresis effective and when should it not be used?

Contents:

  1. Preparative plasmapheresis
  2. Healing plasmapheresis
  3. Plasmapheresis - methods of execution
  4. Plasmapheresis - application
  5. Plasmapheresis - patient preparation
  6. Plasmapheresis - complications

Plasmapheresisis also referred to as " plasma exchange " (TPE, therapeutic plasma exchange). This method consists in collecting plasma by centrifugation or filtration in order to purify it from substances such as, among others, albumin, IgG, IgA, IgM, fibrinogen, cholesterol, and triglycerides.

During plasmapheresis, cellular blood components are re-transfused to the patient. The collected plasma is replaced with either a replenishment fluid or, less frequently, selective plasma purification methods are used. In the latter case, the plasma, after collecting and removing unwanted components from it, is re-transfused to the patient.

There are therapeutic and preparative plasmapheresis.

Preparative plasmapheresis

Preparative plasmapheresisis performed in blood donors, it is used to collect plasma for transfusion or for the production of blood products. For a donor to qualify for plasmapheresis, an efficient venous system is required, so that blood can be drawn from one vein in the arm and transfused to the other vein at the same time.

During plasamapheresis, blood samples are collected for testing in order to test for the carrier of infectious diseases.

The advantage of preparative plasmapheresis is that only plasma is collected from the donor and the remaining elements are returned, which does not put a significant burden on the circulatory system.

Recovery from pre-collection is quick and no additional fluid injection is required.

During the year, you can perform up to 12 such treatments, and the break between each of them must not be shorter than 4 weeks.

You can collect 650 ml of plasma at a time.

Conditions correctly carried outplasmapheresis:

  • determination of total protein and immunoglobulin levels before the first treatment
  • electrophoresis of serum proteins
  • blood parameters check before and after the procedure
  • technical condition monitoring: blood flow, filter condition, system pressure

Healing plasmapheresis

Therapeutic plasmapheresis is performed in order to remove pathogenic factors from the circulatory system.

Peripheral venous puncture is used. If the patient's condition does not allow it, a central venous line, for example into the subclavian vein, is selected.

Whether the procedure is considered effective is determined by the number of eliminated:

  • toxin
  • metabolites
  • immunoglobulins, immune complexes
  • antigens

The patient receives a fluid to supplement the collected plasma, usually crystalloids and an albumin solution.

  • Crystalloids , mostly NaCl and glucose, are widely used due to their low price, availability, do not interfere with hemostasis and increase diuresis. Unfortunately, they persist in the body for a short time, so large amounts should be administered. However, increased fluid intake carries a risk of edema.
  • Colloids are also reportedcolloids : albumin stays longer in the vascular bed and better replenishes plasma losses, however, it can cause allergic reactions and adversely affect blood clotting.

Conditions for properly performed therapeutic plasmapheresis:

  • assessment of the coagulation system, bilirubin concentration
  • electrolyte level
  • concentration of pathogens
  • monitoring of pressure and heart rate of the patient
  • skin condition assessment - allergic reactions

Plasmapheresis - methods of execution

  • Sedimentation-centrifugation method- plasma is separated from blood morphotic elements due to different sedimentation rates in the centrifuge field.
  • Manual method- separation of cell components separated in the centrifugation process using mechanical or automatic work Disadvantages: possibility of mechanical damage to blood cells, significant hemolysis, infection of the hemocytic mass
  • Filter method- transmembrane separation - blood flow through specific filters, with a specific pore thickness, which allows the separation of morphotic elements from the plasma, which is then removed with various substances. : the use of filters can induce anaphylactic reactions and activate complement
  • Plasmapaperfusion method- filtration fromthe use of immunoadsorbents: chemically inert carrier, an antigen with a specific affinity for a specific class of antibodies

Plasma cleansing:

  • interrupted method- this method consists in dividing blood into plasma and morphotic elements, and then cleaning or removing plasma and re-transfusing morphotic substances in an appropriate volume of replacement fluids. The disadvantage of this method is a temporary reduction in blood volume in the patient's body
  • continuous- involves simultaneous collection, cleaning and re-transfusion of blood

Plasmapheresis - application

Preparative plasmapheresis is the collection of plasma for therapeutic purposes. It is also used to obtain material for the production of plasma-like preparations:

  • albumin
  • immunoglobulins
  • fibrinogen

Plasma can also be used to obtain pooled platelet concentrate, leucocyte-depleted pooled platelet concentrate.

In turn, therapeutic plasmapheresis is one of the methods of cleansing the patient's blood of toxins. It improves the prognosis and is also one of the methods of treating immunological diseases.

Classification of indications for plasmapheresis treatment:

1. Standard Treatment of Choice:

  • Goodpasteure's syndrome with anti-membrane antibodies
  • Guillain-Barry syndrome
  • myasthenia gravis
  • thrombotic thrombocytopenic purpura

2. Supportive therapy:

  • cold agglutinin disease
  • immune thrombocytopenic purpura
  • glomerulonephritis
  • familial hypercholesterolaemia
  • systemic vasculitis
  • acute renal failure accompanying myeloma

3. No confirmation of the effectiveness of plasmapheresis treatment:

  • poisoning
  • organ and tissue transplants
  • multiple sclerosis
  • systemic scleroderma
  • generalized progressive atherosclerosis

4. Lack of effectiveness of plasmapheresis:

  • AIDS
  • psoriasis
  • rejection of transplanted kidney
  • rheumatoid arthritis
  • schizophrenia

Plasmapheresis - patient preparation

The equipment and the patient should be properly prepared, one-time sterile sets recommended by the manufacturer must be used. Pressure, pulse and temperature are measured before each treatment.

If the patient's plasma is removed and FFP (fresh frozen plasma) is administered, the nurse must check compliance.

This iscomparing the blood group of the transfused component with the patient's blood group in AB0, checking the expiration date of the component. The thawed plasma should not contain discoloration, clots and undissolved fragments.

It is recommended that the patient defecates before the procedure, eat a light meal, and quit smoking.

Plasmapheresis - complications

Possible complications of plasmapheresis are:

  • drop in blood pressure
  • fainting
  • pale skin
  • headaches
  • dizziness
  • fever
  • nausea, vomiting
  • hypocalcemia
About the authorNatalia MłyńskaStudent of medicine at the Medical University of Lodz. Medicine is her greatest passion. He also loves sports, mainly running and dancing. She would like to treat her future patients in such a way as to see them as a human being, not only a disease.

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Category:

Cardiology