Chapter 37 Hemapheresis

Front 1

Via AABB standards what is the maximun amount of blood which can be in the extracoporeal unit at one time?

Back 1

10.5ml/kg body weight;
note: this is the same volume that can be donated by a blood donor

Front 2

once random donor platelets are pooled, they have a shelf life of?

Back 2

4 hours; apheresis platelets can be available 5 days from when it was collected

Front 3

Via AABB standards, 90% of apheresis platelets tested must have a count of at least?

Back 3

3.0 x 10^11

Front 4

apheresis platelet donors can donate as often as ____, but a maximum of _____ times a year?

Back 4

2 time a week; up to 24 times a year

Front 5

if a person donates a unit of whole blood, he must wait ____ before he can donate apheresis platelets again?

Back 5

8 weeks

Front 6

is there a requirement for platelet count the first time someone donates apheresis platelets?
someone who donates every 2 weeks?

Back 6

first time platelet donars dont need a platelet count performed; for those who give every 4 weeks or more , their platelet count must be at least 150,000/microliter

Front 7

75% granulocyte preparations must have a minimum of ____granulocytes.

Back 7

1.0 x 10^10

Front 8

storage requirements for granulocytes?

Back 8

granulocytes are stored at room temp 20-24*C, and have a short 24hour shelf life

Front 9

which of the following are recommended or required for granulocytes donated to another person?
ABO or crossmatch compatible?
CMV?
HLA match?

Back 9

because of the high number of RBCs in granulocyte units, they must be crossmatch/ ABO compatible;
as there are some lyphocytes in the unit, CMV is a concern ;
an HLA match is critical as well

Front 10

three advantages of hematopoietic progentor cell (HPC) harvest and transplant over traditional bone marrow harvest?

Back 10

donor tolerate a peripheral blood procedure better than they do a marrow harvest, which requires general anesthesia;
the recipient is restored to hematopoietic and immune function more rapidly in HPC than he is with marrow transplants
patients can donate HPC autologously by peripheral HPC harverst were the only option, a tumor-filled marrow would offer little or less in the way of HPCs

Front 11

what are two approches to HPC mobilization, the efforts to maximize the harvest of the CD34+ cells?

Back 11

one approach is the postchemotherapy rebound harvest; at about day 14 after chemoptherapy has begun, there is a significant increase in the number of peripheral hematopoietic progentor cells
the second is treatment of normal (allogeneic) donors with cytokines such as G-CSF and GM-CSF to increasetheir HPC count prior to donation

Front 12

True/False: In thrombocytosis, the platelet count does not correlate well with the risk of thrombosis.

Back 12

True; however, increasing age, a previous thrombotic event and a longer duration of thrombocythemia are all risk factors for thrombosis

Front 13

What are the major indications for therapeutic leukapheresis?

Back 13

relieving vascular occlusion symptoms, such as neurologic deficits and pulmonary congestion and minimizing tumor lysis syndrome

Front 14

What are the three main categories of transfusions for sickle cell anemia patients?

Back 14

1) acute simple transfusion to improve oxygen-carrying capacity;
2) a chronic simple transfusion to suppress red cell production of cells filled with HBS
3) red cell exchange transfusion to traet acute chest syndrome

Front 15

13yog with sickle cell anemia presents with acute chest syndrome; her Hct is 19% and a peripheral blood smear shows almost exclusively sickled cells; the clinician requests 2 units of packed RBC.

Back 15

acute chest syndrome is one of the indications for red cell exchange instead of acute simple transfusion; the goal would be to get the hematocrit to about 30% and the HbS to less than 30%

Front 16

photopheresis is a modification of traditional apheresis techniques where T cells are treated with UVA and then returned to the patient ; it is used to treat several diseases, but the most complete studies of its efficacy have been on the first disease it was used to treat

Back 16

cutaneous T cell lymphoma

Front 17

three advantages of red cell exchange

Back 17

red cell exchange provides a decreased amount of HbS without increasing the hematocrit/blood viscosity;

fewer units of red cells are needed to achieve the same HbS percentage;

there is a smaller contribution to iron overload, as iron is removed with the patient's own sickled cells in the exchange process.

Front 18

what would be the increased benfit of performing a 3 plasma volume exchange in a therapeutic plasmapheresis versus a 2.0PV exchange

Back 18

there is little benefit from exchanging more thean 1.5-2.0 plasma volumes

Front 19

most widely used replacement fluid in therapeutic plasmapheresis

Back 19

5% albumin is the most widely used replacement fluid; it is not indicated for every plasmapheresis

Front 20

staphylococcal A protein is used to makje plasmapheresis a selective procedure, removing unwanted plasma elements; what does staphylococcal A column remove?

Back 20

staphylococcal A protein removes IgG1,2 and 4 and to a lesser gegree IgG3 from plasma

Front 21

what two diseases have the FDA approval for the staphylococcal column

Back 21

the FDA has approved the staphylococcal A protein column method for the treatment of ITP and refractory cases of rheumatoid arthritis

Front 22

what methods of low-density lipoprotein (LDL) removal are currently FDA approved in the USA?

Back 22

the FDA has approved the dextran sulfate and heparin-induced extracorporeal low density lipoprotein precipitation(HELP) methods for use

Front 23

which diseases are considered category I for plasmapheresis (primary or standard form of therapy)?

Back 23

the key category I diseases are acute inflammatiory demyelinating polyneuropathy, anti-basement membrane antibody disease, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis and TTP

Front 24

why is FFP the replacement fluid in the plamapheresis for many forms of thrombotic thrombocytopenic purpura?

Back 24

normal plasma provides proteinase that cleaves those unusually large vWF multimers

Front 25

what are the first three actions that should be taken for an apheresis patient who complains of perioral tingling and lightheadedness

Back 25

in a patient exhibiting symptoms of low ionized calcium, replenishing with oral calcium (TUMS) is the key first step; also slowing the reinfusion to allow for greater dilution of the replacement fluid and increasing the blood/citrate ratio will help; only if these do not alleviate the symptoms does on need to give intravenous calcium