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The Experience
of the Clinical Emergency County
Hospital Sibiu
Apheresis = separation
Greek apairesos / Roman aphairesis: “to
take away”
Process in which blood is removed from a
patient and continuously separated into
component parts; allowing a component to be
retained while the remainder is returned to
the patient.
Cascade filtration: Definitions
Cascade filtration - 2 steps process during which plasma is first
extracted from the blood and then circulated through a second filter,
the plasma fractionator.
The plasma fractionator - membrane pore size 10 folds smaller
than a plasmafilter and retains larger substances - IgG/IgM and
LDL-cholesterol.
Cascade filtration - the separation of plasma from blood can be
obtained by centrifugation or filtration.
Double filtration plasma is extracted from blood by filtration. As the
second step is also done by filtration the process in this case can be
named double filtration.
Double filtration is often named DFPP (Double Filtration
PlasmaPheresis)
Plasma exchange vs. cascade
filtration
Plasma exchange - plasma is discarded and replaced by fluids such as
albumin or FFP.
Cascade filtration - plasma is filtered to retain targeted substance (antibodies
or cholesterol) before being returned to blood.
TPE Cascade Filtered
Filtration plasma
Plasmafilter
Plasma
fractionator
Discarded plasma Replacement fluid
Principles of Double Filtration
Plasmapheresis (DFPP)
Molecular weight and sieving coeffcients
10-1
1 10 102 103 104 nm
Nadler’s formula + hematocrit or:
Cascade filtration clearance
according to the sieving coefficient
Number of patients 2 --
Number of sessions 6
S. Guillan-Barre --
Diagnostic
Multiple myeloma
-- --
Outcome
2014
TPE DFPP
Number of 5 1
patients
Number of 16 3
sessions
Number of 6 3
patients
Number of 20 7
sessions
Number of 32 13
sessions
Thrombotic
microangiopathy 1 pt.
Number of 20 6
sessions
S. Guillan-Barre 3 pt.
S. Guillan-Barre 1 pt.
Neuromyelitis optica
Diagnostics spectrum disorders (NOSD) Neuromyelitis optica spectrum
1 pt. disorders (NOSD) 1 pt.
M. Sava, A. S. Bereanu
Conference: Abstracts of the 3rd Congress of the European Academy of Neurology, Amsterdam,
The Netherlands, June 2017 At: Ansterdam,Netherlands Volume: European Journal of
Neurology,Volume 24, Issue Supplement S1
AN ALTERNATIVE THERAPY TO HIGH DOSE
IMMUNOGLOBULINS IN SEVERE NEUROIMMUNE
DISORDERS - THERAPEUTIC PLASMA EXCHANGE
AND DOUBLE FILTRATION PLASMAPHERESIS
C. Roman-Filip, M. Sava, A. Bereanu, A. Lăzăroaie, F. Gligor
20 patients
Revista Farmacia,with
datasevere
in press neurologic diseases requiring
TPE or DFPP (Nov. 2012 – Dec. 2016)
GBS, MG, NMO, CIDP
Indication, complications and efficacy of these
procedures were analysed
Neurological improvement was recorded in 80% of the
patients
5% had no improvement
Mortality was 15%.
AN ALTERNATIVE THERAPY TO HIGH DOSE
IMMUNOGLOBULINS IN SEVERE NEUROIMMUNE
DISORDERS - THERAPEUTIC PLASMA EXCHANGE
AND DOUBLE FILTRATION PLASMAPHERESIS
Neurological improvement rate is similar to other
studies.
No patient presented catheter related
complications.
Systemic complications (hypocalcemia,
hyponatremia, hypokaliemia, hypotension) were
mild, transient and completely reversible.
Death was secondary to sepsis not related to the
apheresis procedure (nosocomial pneumonia)
TPE and DFPP
In many disorders - first line therapy
Cheaper then IVIG
Safe and efficient
Relatively easy to perform
Low complication rate
DFPP
No need or little need for substitution
No allergic rections
No complications of FFP infusion