Thread by @edgarvlermamd

Therapeutic Apheresis 101
📌 Extracorporeal procedures whereby blood separation technology is used to remove abnormal blood cells and/or plasma constituents
🔲 Plasmamapheresis
🔲 Leukapheresis
🔲 Erythrocytapheresis
🔲 Thrombocytapheresis
#Nephpearls #DialysisDirector

In plasmapheresis, or therapeutic plasma exchange (TPE), large quantities of plasma are removed from a patient and replaced with
👉🏼 Fresh frozen plasma (FFP), or
👉🏼 Albumin solutions in normal saline
#Nephpearls #DialysisDirector

Comparison of Membrane Plasma Separation and Centrifugal Apheresis #Nephpearls #DialysisDirector

Complications of Plasmapheresis #Nephpearls #DialysisDirector

Strategies to avoid complications during Plasmapheresis
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Plasmapheresis: Choice of Replacement Solution #Nephpearls #DialysisDirector

Plasmapheresis: Vascular Access
📌 Centrifugal Apheresis
👉🏼 BFR 40–50 mL/min
👉🏼 Large peripheral vein (antecubital vein) access
📌 Membrane Plasma Separation
👉🏼 BFR 100-150 mL/min
👉🏼 Central vein access (large bore dual-lumen catheter)
#Nephpearls #DialysisDirector

Plasmapheresis: Albumin
👉🏼 5% albumin solution at a concentration of 5 g/dL (50 g/L) in saline with 130–160 mmol of NaCl per liter can be replaced in a volume equal to that of the removed plasma
#Nephpearls #DialysisDirector

Plasmapheresis: Complications
📌 The most common complication of therapeutic apheresis when using centrifugal machines is related to citrate toxicity
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Plasmapheresis: Complications
📌 Hypotension (2% overall incidence) is due mainly to intravascular volume depletion, which may be exaggerated by the large (250–375 mL) volume of blood externalized in the extracorporeal circuit
#Nephpearls #DialysisDirector

Plasmapheresis: Complications
After 1 plasma exchange
📌 Fibrinogen ⬇️ by 80%
📌 PT & other clotting factors ⬇️ by 50-70%
📌 PTT ⬆️ by 100%

24 hours after
📌 Fibrinogen ~ 50% of initial levels
📌 Antithrombun III levels ~ 85% of initial levels
#Nephpearls #DialysisDirector

Plasmapheresis: Complications
📌 Hypokalemia: When using Albumin as replacement solution, there could be a 25% ⬇️ in serum K in the immediate post-apheresis period

👉🏼 Add 4 mmol of K to each liter of replacement solution
#Nephpearls #DialysisDirector

Indications for Urgent Plasmapheresis and Cytapheresis
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Plasmapheresis: Treatment of Anti-GBM disease
#Nephpearls #DialysisDirector
👉🏼 cjasn.asnjournals.org/content/clinja…

Plasmapheresis: Treatment of TTP/ADAMTS13 deficiency mediated TMA
#Nephpearls #DialysisDirector
👉🏼 cjasn.asnjournals.org/content/clinja…

PEXIVAS: Plasmapheresis does not improve composite endpoint of death/ ESKD
👉🏼 ⬇️ dose of steroids was as effective as standard dose w/ fewer serious infections
👉🏼 “Double positive” patients should be treated with plasmapheresis (as in anti-GBM)
#Nephpearls #DialysisDirector

Principles of Separation: Indications and Therapeutic Targets for Plasma Exchange ca. 2014 from @CJASN
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👉🏼 cjasn.asnjournals.org/content/clinja…