The Rationale for Therapeutic Plasma Exchange

January 29, 2018 | Author: Anonymous | Category: Science, Health Science, Immunology
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The Rationale for Therapeutic Plasma Exchange Stuart L. Goldstein, MD Professor of Pediatrics Baylor College of Medicine Medical Director, Renal Dialysis and Pheresis Service Texas Children’s Hospital Houston, Texas

Outline • Principles of TPE – Centrifugal TPE – Membrane TPE

• What rationale exists for TPE? – When should TPE be considered – AABB, ASFA classifications

• Specific disease entities

Membrane vs. Centrifugation • In the US, most TPE is performed by centrifugation.  One machine can do all apheresis procedures. • Double filtration method: first membrane separates plasma from cellular portion and second membrane separates globulin from albumin.

Blood Components Separated by Centrifugation

Platelets

Plasma

Lymphocytes Monocytes Granulocytes

Neocytes Erythrocytes

Plasma Exchange

TPE: Available techniques techniques... • Cascade or secondary filtration: Separated blood is perfused through a plasma filter (1) to remove certain plasma elements. The second column (2) (cascade) absorbs the element and the plasma is returned to the patient. 1

2

PATIENT

Plasma removal is affected by: • Qb • Hct • Pore Size • TMP =Plasma effluent

Qb 100-150 Hct 25-45%

Pore Size

TMP 1, oliguria)

• ULVWF seen in 15/25 patients with decreased ADAMTS-13 activity and TAMOF (technique?) • All four pts with activity
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