Diferencia entre revisiones de «Plasmapheresis»
Sin resumen de edición |
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| Línea 30: | Línea 30: | ||
==Contraindications== | ==Contraindications== | ||
*Hemodynamic instability, sepsis, or other conditions causing inability to tolerate fluid shifts | *[[shock|Hemodynamic instability]], [[sepsis]], or other conditions causing inability to tolerate fluid shifts | ||
*Inability to tolerate central line placement | *Inability to tolerate central line placement | ||
*Allergy to [[FFP]] or albumin | *Allergy to [[FFP]] or albumin | ||
| Línea 54: | Línea 54: | ||
**[[Sepsis]] | **[[Sepsis]] | ||
**[[Transfusion infections]] | **[[Transfusion infections]] | ||
* | *Immunosuppression | ||
*[[Hypocalcemia]] | *[[Hypocalcemia]] | ||
*Complications of [[central line]] placement | *Complications of [[central line]] placement | ||
Revisión del 17:23 1 oct 2019
Overview
- Involves extracorporeal separation of blood products, resulting in filtered plasma product
- Patient's plasma is removed, blood cells re-infused, and (usually) donor plasma transfused
- In US and other high-resourced settings, separation typically done by automated centrifuge
Indications
- Established indications for plasmapheresis as first-line treatment (either alone or in conjunction with other agents)
- Guillain-Barre syndrome
- Thrombotic thrombocytopenic purpura
- Myasthenia gravis
- Hyperviscosity syndrome
- Diffuse alveolar hemorrhage due to Goodpasture syndrome
- Chronic inflammatory demyelinating polyneuropathy
- Severe autoimmune hemolytic anemia
- Indications for which plasmapheresis is accepted second-line therapy:
- Lambert-Eaton myasthenic syndrome
- Multiple sclerosis: acute CNS demyelination unresponsive to steroids
- Rapidly progressive vasculitis
- Catastrophic thrombosis due to antiphospholipid syndrome
- Acute disseminated encephalomyelitis
- Severe systemic lupus erythematosus
- Multiple myeloma cast nephropathy
- RBC alloimmunization in pregnancy
- Mushroom Poisoning
- Hemolytic uremic syndrome
- Less established, possible indications
- Thyroid storm when antithyroid drugs ineffective or contraindicated
- Pemphigus vulgaris (severe and refractory to first-line management)
- Pyoderma gangrenosum
Contraindications
- Hemodynamic instability, sepsis, or other conditions causing inability to tolerate fluid shifts
- Inability to tolerate central line placement
- Allergy to FFP or albumin
- Severe hypocalcemia (citrate anticoagulant will precipitate calcium and worsen hypocalcemia)
Equipment Needed
- Dialysis or pheresis catheter
- Central line supplies
- Automated centrifuge or semipermeable membrane
- FFP
Procedure
- See central line
- Additional steps specific to device being used to apherese, consult specialist for this!
Complications
- Transfusion reactions
- Immunosuppression
- Hypocalcemia
- Complications of central line placement