PLASMAPHERESIS

By

Dr.Mohamed Abd El Gawad

Nephrology Specialist at New Mansoura

General Hospital
 Agenda
 What is Plasmapheresis ?
 INDICATIONS FOR PLASMAPHERESIS
 TECHNIQUES
 Replacement fluid
 Vascular access
 Anticoagulation
 Regimens of PE
 Complications
What is Plasmapheresis ?
INDICATIONS FOR PLASMAPHERESIS
 TECHNIQUES

 A: Centrifugal plasma separation : blood cells

are separated during centrifugation , there
are two centrifugation methods Intermittent
flow device and continuous flow device

 B: membrane plasma separation : plasma

separators use membranes with a molecular
weight 3 million
 membrane plasma separation
 Uses highly permeable hollow fibers with membrane pores
of 0.2to 0.5 µm.

 The hollow fiber functions as a membrane, with the pore

size (0.2to 0.5 µm) allowing transport of plasma across the
membrane while retaining other blood components.

 PlasmaFlux filters contain the polysulfone-based

Plasmasulfone membrane, which has been designed to
minimise the activation of the patient’s immune system
during blood–membrane interaction
 Plasma volume

 Plasma volume =
( 0.07 × Body Weight ) × ( 1 - Hct )

( 0.07 × 70 ) × ( 1 - .4 )
= 2.9 L
 Serum Albumin

 Serum Albumin : 4 g /dL

40 g /L

40 × 3 = 120 g /3L
 Electrolytes
Calcium:
10 ml of calcium gluconate solution per liter of
replacement solution

Potassium :
4 mmol of Potassium to each liter of
replacement solution
 Vascular access

 Standard central venous catheters

 Arteriovenous(AV) fistula

 Peripheral access through large-bore, short,

intravenous cannulae
 Anticoagulation
1 - Citrate
 IT is used for centrifugal plasma exchang.

 citrate has particular advantages in patients at higher

bleeding risk in view of its lack of systemic anticoagulant
actions.

 Citrate is rapidly metabolized by the liver (normal levels

within 4 hours).
Hepatic dysfunction ⇒ severe hypocalcemia
 2 – Heparin

 Used for membrane plasma filtration

 Higher doses may be needed than in hemodialysis as a
result of increased losses during the procedure (heparin
is protein bound).
 Bolus doses of unfractionated heparin 2000 to 5000 U
are given initially, and then 500 to 2000 U/h.
 Regimens of PE?

Volume of Frequency of Duration of

exchange procedures therapy

1-1.5 plasma
volume
 Frequancy of procedures
1- Daily plasma exchange
 Most effective in rapidly depleting total body load.
 Intensity of exchanges has no major effect on
outcomes except in hemolytic-uremic syndrome.

2- Alternate-day exchanges
 proven efficacy in antineutrophil cytoplasmic
antibody (ANCA)–associated diseases.
 A single plasma volume exchange will lower
plasma macromolecule levels by
approximately 60% .

 Five exchanges during 5 to 10 days will clear

90% of the total body Immunoglobulin
 Target molecule kinetics during therapeutic plasma exchange.

Mark E. Williams, and Rasheed A. Balogun CJASN

doi:10.2215/CJN.04680513

©2013 by American Society of Nephrology

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