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Plasmapheresis Periprocedural Care

  • Author: Elliot Stieglitz, MD; Chief Editor: Emmanuel C Besa, MD  more...
 
Updated: Dec 21, 2015
 

Equipment

Plasmapheresis can be accomplished through centrifuge-based platforms such the Cobe Spectra, Fenwal Aurora, and the Fresenius COM.TEC series of devices. Patients require either a double-lumen central venous catheter or two large-bore antecubital peripheral lines.

Plasmapheresis can be performed using a semipermeable membrane-based device in combination with hemodialysis equipment. Central lines, as opposed to peripheral lines, are required for membrane-based plasmapheresis because of their higher flow rates of roughly 100-150 mL/min, as compared with 50-70 mL/min for centrifuge-based equipment.

Two types of membrane-based plasmapheresis technologies exist: hollow fiber and parallel plate. Hollow-fiber dialyzers consist of a bundle of capillaries potted (glued) at both ends into a plastic cylindrical shell. Parallel-plate dialyzers contain layers of stacked membranes with ridges and grooves. Both technologies allow for the separation of plasma from the cellular components of blood based on particle size as well as pressure gradients.

The major advantage of hollow-fiber dialyzers is that they are considered more gentle than parallel-plate technology and are therefore more commonly used in pediatrics. Parallel plate dialyzers on the other hand require less blood volume and therefore less anticoagulant, thereby minimizing the side effects associated with citrate or heparin. Asahi Plasma-Flo is an example of hollow fiber technology, and Cobe TPE is an example of parallel plate technology.

An advantage of membrane-based plasmapheresis is that multiple cycles of filtration and ultrafiltration can take place, potentially allowing for the return of beneficial plasma elements while discarding the pathogenic components.[5]

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Patient Preparation

Anesthesia

Anesthesia is occasionally used during central line placement in preparation for plasmapheresis if the patient does not already have a central line. However, anesthesia is rarely used during the plasmapheresis session itself. In pediatrics, opioids such as morphine and benzodiazepines such as lorazepam are occasionally used for temporary pain relief and anxiety control, respectively.

Positioning

The patient is placed in the supine position. The head of the bed is flat or elevated to a reverse Trendelenburg position in accordance with the patient's comfort. If an internal jugular line is being used, the patient's neck may have to be repositioned to permit proper flow.

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Monitoring & Follow-up

Patient's vital signs are monitored every 15 minutes, particularly for signs of volume depletion (eg, tachycardia and hypotension). Signs and symptoms of hypocalcemia (eg, numbness or tingling of the fingers, nose, or tongue) are also checked carefully. In pediatric patients, symptoms of hypocalcemia can include abdominal pain, nausea, or vomiting.

Long-term monitoring

Delayed transfusion reactions can be seen several days after the transfusion ends, and patients should be alerted to the signs and symptoms so that they can seek medical attention.

Infection related to the use of central venous catheter is a potential complication. Sterile technique can minimize the likelihood of this possibility. Infection related to the use of blood products is another potential complication that should be raised as part of the initial consent.

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Contributor Information and Disclosures
Author

Elliot Stieglitz, MD Pediatric Oncologist, University of California, San Francisco, School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

James Huang, MD Clinical Professor of Pediatrics, Director of Pediatric Hematology, University of California, San Francisco, School of Medicine

James Huang, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, Hemophilia and Thrombosis Research Society

Disclosure: Received grant/research funds from Baxter Healthcare Corporation for research; Received grant/research funds from BPL for research.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Acknowledgements

Acknowledgments

The authors wish to thank Beth DuVardo, RN, and Lillian Larue, RN, of the Apheresis Unit at University of California, San Francisco, School of Medicine for their assistance with this article.

References
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