Documenti di Didattica
Documenti di Professioni
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. Platelets
. Plasma
. Red blood cells
. Red blood cells and plasma
. Granulocytes
. Allogeneic progenitor cells
Sedimented blood sample
100 –
90 –
80 – Plasma
Plasma
70 – Areas of
Platelets predominance
60 –
WBC Lymphocytes predominance
50 –
Leukocytes Platelet Rich layer Monocyte predominance
40 –
Granulocyte predominance
30 – Neocytes
Erythrocytes
20 – Erythrocytes
10 –
Principle of apheresis
Plasma
Platelets
Whole blood Lymphocytes Whole blood
Granulocytes
(vein) (vein)
Erythrocytes
Trans-membrane Pressure
. Difference between the pressures at both sides of the membrane
(blood/plasma).
. Usually must be kept below 50 mmHg to avoid RBC hemolysisand/or pore
blocking.
Hematocrit
. As blood is flowing along the fiber, plasma is being continuously removed
and the HCT increases.
. Plasma removal must be limited to avoid exceeding a critical HCT and
blood viscosity that could cause membrane blocking.
Shear Rate
. Flow below which blood cells adhere to the membrane
. Blood flows need to be faster the shear rate to avoid blocking of the pores.
Centrifugal Separation
Sv = 2 w2 R r2 (r-ro)9µ
Cellular Sv is proportional to:
Centrifugal Acceleration (w2 R ) or g
Square of the radius (r) of the cell
Difference between plasma and cell
densities (r-ro)
Inverse of fluid viscosity (µ)
Centrifugal Separation
PB/BN/MME
Continuous-flow centrifugation
Withdraw, process and return blood
simultaneously
Two venipuncture sites
Less extracorporeal volume
Less time required
Cell Separators
Types of Apheresis
Donor apheresis
Erythrocytes
Platelets
Plasma
Progenitor (stem) cells
Therapeutic apheresis
Plasma exchange (TPE)
Cytaphersis
Erythrocytapheresis
Leucapheresis
Thrombocytapheresis
Extracorporeal photopheresis
Donor Criteria
Criteria for whole blood donation
Adequately trained operator
A physician familiar with all aspects of apheresis must be
available during the procedure
Routine premedication of the donors to increase the
component yield is not recommended
Volume of extracorporeal blood ≤15% of the donor’s
estimated blood volume
History of thrombosis, Protein C or S deficiency, factor V
Leiden
Plasmapheresis
Not more than 500ml per procedure in the
absence of volume replacement
Priming
0.9 % saline
Blood (ECV:≥10%, anemic & hemodynamically unstable patients)
Replacement fluid
4% albumin
FFP
Combination (0.9% saline, 4% albumin, plasma)
Complications of TPE
Vascular access complications
Fall in Plasma protein levels
(Ig, C3, ALP, SGOT)
Coagulation factors
(Antithrombin III)
Citrate toxicity
Allergic reaction
Fall in blood pressure
Increased risk for infections
TRALI
Mortality?
Citrate Toxicity
Metabolism in mitochondria (Liver, Kidney, muscle)
Ca++
Normal value; Ca++: 1.05 to 1.3 mmol/L (total calcium: 2.25 to 2.75 mmol/L)
Mg++ K+ pH HCO3
Causes
Citrate given too quickly
Citrate given faster than it can be metabolised
Citrate accumulation due to duration of the procedure
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