Prof A Pourazar Immunohematologist

Transcription

1 Prof A Pourazar Immunohematologist

2 What is plasma? Plasma is part of blood. It is the liquid that supports the circulation of red blood cells, white blood cells and platelets. Plasma is mainly water and contains dissolved minerals, proteins and antibodies. If blood is allowed to separate, the plasma will look yellow and the rest of the blood will look red.

3 What is plasmapheresis (plasma exchange)? Plasma exchange is a procedure that removes plasma from the blood and replaces it with new plasma fluid. Blood is removed from the patient (a small amount at a time) and separated so that the plasma can be discarded. The red and white blood cells and the platelets are returned to the patient, along with the replacement fluid. An anti-coagulant is added to the blood to stop it clotting. Throughout the procedure, the blood is pumped around your body system as usual by your heart. Only a small amount is out of the body at any one time.

4 Plasma exchange is always done in hospital and a nurse who is trained in the procedure will stay with you throughout. Before the procedure begins, your doctor will ask you to sign a form giving permission for you to have a plasma exchange. You should be told about the potential risks as well as the possible benefits.

5 How can plasma exchange help me Some diseases can cause harmful substances to circulate in the blood. Plasma exchange allows these harmful substances to be removed by replacing the plasma which contains them. Your doctor will discuss with you the reason why you need a plasma exchange and how it might help.

6 Reasons for Procedure For example, some diseases confuse the body s immune system and cause it to produce substances called autoantibodies, which attack healthy cells. Plasma exchange, in conjunction with drug therapy, may solve the problem by removing the autoantibodies and stopping the body from producing any more. In some cases, this procedure is used to remove toxins or metabolic substances from the blood.

7 Plasmapheresis is used to treat the following: Autoimmune diseases conditions that occur when the body s immune system attacks its own tissues and organs Neurological diseases disorders affecting the nervous system Very high levels of cholesterol that are not reduced by diet and medicines Toxins that can get into your blood

8 Possible Complications Complications are rare, but no procedure is completely free of risk. If you are planning to have plasmapheresis, your doctor will review a list of possible complications, which may include: Anaphylaxis a dangerous allergic reaction to the solutions used in plasma replacement, which usually starts with itching, wheezing, or a rash. Mild allergic reaction to the procedure may cause fever, chills, or rash Infection Bleeding Drop in blood pressure Bruising or swelling Plasmapheresismay not be appropriate for people with certain clotting disorders.

9 What to Expect Prior to Procedure Leading up to your procedure: Review your regular medicines with your doctor. You may be asked to stop taking some drugs. Arrange to have someone drive you home from the hospital. Drink plenty of noncaffeinatedand nonalchoholicbeverages. The day of your treatment: Eat a well-balanced meal before going for treatment, unless instructed otherwise by your doctor. Wear comfortable clothing with sleeves that can easily be pulled above the elbows. Bring a book or personal music player to help pass the time during the procedure. Empty your bladder before the procedure.

10 How will the procedure be carried out? Two alternative methods are used to separate plasma from the rest of the blood. One uses a piece of equipment called a plasma filter The other uses a device called a blood cell separator. Your medical team will make a decision based on various factors including the size of your body and the nature of your illness. Both methods require a special intravenous catheter to access the blood.

11 You will be asked to lie in a bed or sit in a reclining chair. Two needles attached to a catheter tube will be inserted into veins. In some cases, a needle will be inserted into each arm. For others, one needle may be inserted into your arm and the other into the opposite foot. If the veins in your limbs are too small to use, a longduration catheter will be inserted. It will be placed in a vein in your shoulder or groin area.

12 Long-Duration Catheter Placement in Shoulder and Groin

13 Anesthesia Anesthesia is not needed for this procedure.

14 Plasmafiltration Blood is pumped around a machine and through the plasma filter. The holes in the filter are too small to allow blood cells to pass through, so the plasma is sieved out and collected. Replacement plasma is infused into the blood circuit and the whole blood returned to the body.

15 Cell separation Blood is pumped into the cell separator, which spins around fast enough to create a centrifugal force that separates the plasma from the rest of the blood. The machine can then remove the plasma. Replacement plasma is infused into the blood circuit and the whole blood returned to the body.

16 Will it hurt? The procedure does not hurt but it may make you feel tired. You may feel some discomfort when the intravenous access catheter is inserted but this will wear off.

17 How long will it take? A plasma exchange takes about one to three hours, depending on the amount of plasma that needs to be removed and your body size. You will need to be connected to the plasma exchange machine, either sitting in bed or in a chair, You can eat and drink during the procedure. Immediately after procedure, you will be asked to rest for a short period of time.

18 How many plasma exchanges will need? Frequency of treatments will depend on your diagnosis and your medical condition. The doctor will usually recommend one exchange a day for a minimum of five days. You will most likely need to have several treatment sessions per week for two weeks or more. More will be prescribed if the medical team feel this would be beneficial. The intravenous catheter will remain in place for as long as it is needed.

19 Where will it happen? The procedure can be done anywhere in the hospital The plasma exchange will usually be carried out on the Dialysis Unit, with other who are undergoing similar procedures. However, it may also be done by your bedside Plasmpheresis Unit also is good for this procedure.

20 Who will do the plasma exchange? A nurse trained in the procedure will perform the treatment and stay with you all the time. Any adverse effect will be told to your Doctor Procedure will be done without any difficulty

21 Are there any risks associated with plasma exchange? There is a small risk that you may have an allergic reaction to the replacement plasma. Medication may be given before each exchange to minimize this risk. Donated blood products will be used in the procedure. This will be mostly albumin (a vital protein in the blood stream) but will include some blood or plasma. There is a small risk that diseases can be passed on in this way, but every product used is screened according to recommendations from the transfusion service.

22 The exchange of large volumes of plasma may cause shifts of fluid that can lead to changes in blood pressure, cold hands and feet or breathlessness. If the symptoms persist, your medical team may recommend that the plasma exchange should be stopped. Plasma exchange will lower or suppress the body's immunity (its ability to fight disease). Over a few days this should not cause problems. However, if you have already been treated with immunosuppressive drugs there is a greater risk of infection.

23 Are there any side effects from the procedure? Possible side effects during the treatment include dizziness, nausea or a feeling of cold. If at any time during the procedure you detect any symptoms you should tell your nurse. He or she will be able to adjust the procedure accordingly. And they can help you

24 The nurse will also monitor your vital signs (for example, your blood pressure) during the plasma exchange, in order to detect any problems as quickly as possible. You may feel tired after the plasma exchange But don t worry about it You will feel good after sometimes

25 How soon can I go home after the plasma exchange? In most cases you will receive plasma exchange as an inpatient because the range of treatments prescribed for your condition requires a hospital stay. However, if you are able to go home, it is possible to come in to hospital just for a day to have plasma exchange. As long as there are no problems during the procedure, you will be able to go home after a short rest.

26 Post-procedure Care When you return home, do the following to help ensure a smooth recovery: Avoid hot foods or beverages for at least two or three hours after treatment. They can dilate blood vessels and may make you feel light-headed. Avoid sun and hot weather on the day of treatment. Avoid hot showers and saunas on the day of treatment. To lessen the chance of excessive bleeding, do not shave or cut your fingernails for at least 4-6 hours after treatment. You can usually return to your regular activities the day of your treatment. Be sure to follow your doctor's instructions. Improvement can occur within days or weeks, depending on the condition being treated. Benefits usually last for up to several months, but may last longer. Over time, autoantibodies may again be produced by your body. Because of this, plasmapheresis is mainly used as a temporary treatment.

27 Call Your Doctor After you leave the hospital, contact your doctor if any of the following occurs: Excessive bruising, bleeding or swelling at the needle insertion sites Signs of infection, including fever and chills Seizures Excessive itching or rash Nausea and/or vomiting Pain that you cannot control with the medicines you have been given Cough, wheezing, shortness of breath, or chest pain Irregular heartbeat Abdominal pain Joint pain, fatigue, stiffness, or other new symptoms Yellowish tone to your skin or eyes

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