PLASMA EXCHANGE THERAPY AND IMMUNOADSORPTION

PLASMA EXCHANGE THERAPY AND IMMUNOADSORPTION INDICATIONS AND PROCEDURE

1. Immunoadsorption and therapeutic plasma exchange Ryan dave Viloria, rn Hemodialysis nurse

2. Immunoadsorption and therapeutic plasma exchange Ryan dave Viloria, rn Hemodialysis nurse

3. Objectives: To understand Therapeutic Plasma Exchange and Immunoadsorption To identify possible complications that occur during the treatment of Therapeutic Plasma Exchange and Immunoadsorption. to familiarize the mechanism of action in Therapeutic Plasma Exchange and Immunoadsorption

4. Therapeutic plasma exchange Ryan Dave Viloria

5. Plasmapheresis A general term used to denote the automated, selective removal of plasma. Plasmapheresis uses centrifugation to separate the blood components, in contrast to dialysis, which uses filtration to separate small molecules from blood. Plasma Exchange Is a procedure in which blood of the patient is passed through a medical device which separates out plasma from other components of blood, the plasma is removed and replaced with a/or replacement solutions such as fresh frozen plasma (FFP) and/or 5% human albumin with NaCl 0.9%.

6. types Centrifugation takes advantage of the different specific gravities inherent to various blood products, such as red blood cells (RBCs), white blood cells (WBCs), platelets, and plasma. Cytapheresis - A procedure in which various cells can be separated from the withdrawn blood and retained, with the plasma and other formed elements retransfused into the donor. Requires low blood flow – peripheral venous line Membrane permeability Similar to Hemodialysis Uses semipermeable membrane Requires high blood flow rate ( 100-150ml/min) – Permanent Access

7. Plasma Exchange Diagram

8. Separation Mechanism of plasma exchange

9. Plasma removal is affected by: Blood Flow Hematocrit Pore size TMP

10. Indications Category I standard acceptable therapy Category II sufficient evidence to suggest efficiency usually as adjunctive therapy Category III suggestion of benefit for which is insufficient to establish the efficiency of tpe or to clarify the risk/benefit ratio associated with tpe Category iv lack of efficiency in controlled trials

11. complications Complications Involving Vascular Access Hematomas Pneumothorax Catheter Infections Complications Involving Replacement Fluids Anaphylactoid reactions to FFP Coagulopathies Transmission of viral infections Hypocalcemia Hypokalemia Other Complications Hypotension Dyspnea Thrombocytopenia Removal of erythropoietin and drugs bound to plasma proteins

12. Liposorber system KANEKA MA-03 PA2 Apheresis Machine Indicated for use in performing low density lipoprotein cholesterol (LDL-C) apheresis to acutely remove LDL-C from the plasma of the following high risk patient populations for whom diet has been ineffective and maximum drug therapy has either been ineffective or not tolerated: Patients with LDL-C  > 300 mg/dl Patients with LDL-C  > 200 mg/dl and documented coronary heart disease (CHD).

13. Immunoadsorption Ryan Dave Viloria

14. immunoadsorption

15. Adasorb ® ( medicap clinic gmbh ) Secondary system for controlling and monitoring adsorbers for extracorporeal apharesis Monitors all predetermined adsorption and desorption parameters of the adsorbers by using microprocessors

16. Adsorber ( globaffin ) The first synthetic broad-spectrum immunoadsorber with peptide GAM Removes immunoglobulins and immune complexes selectively and efficiently IgG elimination rates can be controlled by the volume of plasma treated

17. GLOBAFFIN — efficient and selective autoimmune disease treatment The broadband immune adsorber GLOBAFFIN uses Peptid - GAM ®  ligands for the binding of antibodies.

18. The principle of immunoadsorption The principle of immune apheresis with twin adsorbers . To eliminate antibodies one adsorber is perfused with plasma while at the same time the second adsorber is regenerated.

19. indications

20. indications Transplantation Nephritis Membranous nephropathy Recurrent focal segmental glomerulosclerosis Kidney and transplantation

21. indications

22. indications Hyperlipidemia Dilated Cardiomyopathy Myocardial Infarction Heart and Cardiology

23. indications

24. indications Atopic Dermatitis Pemphigus Vulgaris Skin and Dermatology

25. indications

26. indications Guillain-Barré Syndrome Myasthenia Gravis Autoimmune Encephalitis Vascular Dementia Brain and Neurology

27. Immunoadsorption: Implications for practice Prerequisites: Mastering Hemodialysis basic procedures, mastering fistula and/or catheter procedures Mastering plasmapheresis

28. Immunoadsorption: Implications for practice Implementation of Immunoadsorption: Training to use an ADAsorb monitor

29. Immunoadsorption: Implications for practice Training on how to handle, save, and store adsorbers Set-up and manage Plasma separator machine and Immunoadsorption circuits simultaneously.

30. Immunoadsorption: Implications for practice Outcomes Increase patient’s safety by developing a multi-skilled team during the treatment Less stress and less tiring for patients during the desensitization sequence

31. What happens during immunoadsorption? Hemodialysis access (fistula or CVC) will be used. One of the transplant doctors will explain the procedure and make a timetable.

32. What happens during immunoadsorption? Taking blood group antibody levels Immunoadsorption will be carried out by specially trained nurses who will monitor and look throughout the treatment.

33. What happens during immunoadsorption? Before the procedure starts special blood tests will be taken. A sterile tubing set is used to pump around a machine, through a special filter to separate plasma from the blood.

34. What happens during immunoadsorption? As the antibodies are carried within the plasma, the plasma is passed through an adsorption column to remove the antibodies. The treated plasma and blood will be returned.

35. Possible complications associated with immunoadsorption Allergic Reaction to the filter or adsorption column Dizziness, nausea, feeling cold or tingling sensation in fingers and lips

36. Possible complications associated with immunoadsorption Hypotension Increased risk of infection