Apheresis

by McLeod, Bruce C., M.D.; Price, Thomas H.; Drew, Mary Jo

• ISBN13: 9781563950827
• ISBN10: 1563950820
• Format: Hardcover
• Copyright: 1997-10-01
• Publisher: Amer Assn of Blood Banks

Table of Contents

Preface	p. xix
About the Editors	p. xxiii
Development of Apheresis Instrumentation	p. 1
Cohn Centrifuge	p. 2
Haemonetics Instruments and the Latham Bowl	p. 4
NCI-IBM Blood Cell Separator	p. 5
Sealless Continuous Flow Centrifuge	p. 10
Aminco Celltrifuge II and Fenwal CS3000	p. 14
IBM 2997/COBE Spectra	p. 16
Membrane Plasma Separation	p. 22
Conclusion	p. 25
References	p. 26
Introduction to Apheresis Donations Including History and General Principles	p. 29
Platelets Prepared from Whole Blood: Pooled Random-Donor Platelets	p. 30
Platelet Refractoriness and HLA Matching	p. 30
Concepts of Apheresis	p. 31
Plateletpheresis Using BloodCell Separators	p. 31
Granulocyte Transfusion and Leukapheresis	p. 33
Storage of Granulocytes for Transfusion	p. 39
Donor-Recipient Matching for Granulocyte Transfusion	p. 40
Donor Issues in Apheresis	p. 40
Summary	p. 44
References	p. 44
Introduction to Therapeutic Apheresis	p. 49
Manual Apheresis	p. 49
Automated Cell Separators	p. 51
Automated Therapeutic Cytapheresis	p. 57
Conclusion	p. 61
References	p. 62
Physiology of Apheresis	p. 71
Anticoagulation	p. 71
Fluid Shifts	p. 79
Cellular Loss	p. 81
Plasma Protein Interactions	p. 83
Adverse Effects	p. 84
Summary	p. 89
Acknowledgments	p. 90
References	p. 90
Current Instrumentation for Apheresis	p. 95
Principles of Operation	p. 95
Instruments for Plateletpheresis with or without Plasma Collection	p. 97
Instruments for RBC and Other Component Collection	p. 114
Comparison of Apheresis Systems	p. 123
Summary	p. 128
References	p. 128
Selection and Care of Apheresis Donors	p. 131
Recruiting Apheresis Donors	p. 131
Care of Apheresis Donors	p. 139
Conclusion	p. 141
References	p. 141
Automated Donations: Plasma, RBC, and Multicomponent Donor Procedures	p. 143
Plasma Donation by Apheresis	p. 144
Red Cell and Multicomponent Donation by Apheresis	p. 148
Donor Acceptance, Regulatory Concers, and Administrative Issues	p. 152
Summary	p. 157
References	p. 157
Platelet Function, Kinetics, and Metabolism: Impact on Quality Assessment, Storage, and Clinical Use	p. 161
Platelet Physiology	p. 161
Platelet Transfusion Dose	p. 167
Assessing Platelet Quality	p. 169
Liquid Storage of Platelets in Plasma	p. 170
Storage of Apheresis Platelets	p. 173
Platelet Counting	p. 176
Leukocyte Reduction	p. 177
Cytokines and Transfusion Reactions	p. 178
Conclusions	p. 178
References	p. 179
Provision of Single-Donor Platelet Transfusions: Patient and Producer Perspectives	p. 185
Usage Trends	p. 185
Characteristics of Single-Donor and Pooled Platelets	p. 187
Advantages and Disadvantages of Single-Donor Platelets	p. 190
Summary	p. 195
References	p. 195
Matched Apheresis Platelets	p. 199
Antigen-Antibody Systems Affecting Platelet Transfusions	p. 200
Diagnosis of Alloimmune Refractoriness	p. 205
Matched Platelets in the Management of the Alloimmunized Patient	p. 208
Elements of a Matched Donor Program	p. 214
Summary	p. 215
References	p. 215
Bacterial Contamination of Platelet Transfusions	p. 221
Clinical Presentation	p. 222
Organisms and Sources	p. 223
Methods to Reduce Risk of Posttransfusion Sepsis	p. 225
Conclusions	p. 232
References	p. 233
Granulocyte (Neutrophil) Transfusion	p. 237
Neutrophil (PMN) Physiology	p. 238
Clinical Experience and Limitations of Granulocyte Transfusions	p. 239
Technology of Granulocyte Collection and Transfusion	p. 246
Future of Granulocyte (Neutrophil) Transfusions	p. 249
References	p. 250
Management of the Therapeutic Apheresis Patient	p. 253
Physician and Allied Health Staff	p. 253
Guidelines for Apheresis Therapy	p. 254
The Apheresis Physician as Consultant	p. 257
Extracorporeal Volume Evaluation and Management	p. 259
Vascular Access	p. 260
Intraprocedure Care and Monitoring	p. 264
Management of Special Therapeutic Apheresis Patient Populations	p. 265
Management of Adverse Reactions	p. 268
Records	p. 272
Apheresis Instrumentation	p. 272
Conclusion	p. 273
References	p. 273
Therapeutic Cell Depletion	p. 283
Thrombocytosis	p. 284
Hyperleukocytosis	p. 287
Conclusion	p. 292
References	p. 293
Basic Principles of Therapeutic Blood Exchange	p. 295
Modeling the Effects of Plasma Exchange	p. 296
Reduction of Blood Constituent Levels with Therapeutic Plasma Exchange	p. 303
The Intensity of Therapeutic Plasma Exchange: Volume and Schedule	p. 313
Replacement Fluids for Plasma Exchange	p. 315
Conclusions	p. 316
References	p. 317
Therapeutic Plasma Exchange in Neurologic Disorders	p. 321
Guillain-Barre Syndrome	p. 322
Chronic Inflammatory Demyelinating Polyneuropathy	p. 326
Peripheral Neuropathy with Monoclonal Gammopathy	p. 327
Myasthenia Gravis	p. 329
Lambert-Eaton Myasthenic Syndrome	p. 331
Stiff-Person Syndrome	p. 332
Other Paraneoplastic Syndromes	p. 333
Multiple Sclerosis	p. 334
Other Neurologic Syndromes	p. 336
Summary	p. 337
References	p. 337
Therapeutic Plasma Exchange in Hematologic Diseases and Dysproteinemias	p. 345
Therapeutic Plasma Exchange in Hematologic Diseases	p. 346
Therapeutic Plasma Exchange in Dysproteinemias	p. 361
Summary	p. 365
References	p. 365
TPE in Renal, Rheumatic, and Miscellaneous Disorders	p. 375
Renal Disorders	p. 375
Rheumatic Disorders	p. 384
Metabolic Disorders	p. 390
Solid Organ Transplantation	p. 393
Summary	p. 399
References	p. 399
Red Cell Exchange and Other Therapeutic Alterations of Red Cell Mass	p. 411
Red Cell Exchange: Technical Considerations	p. 411
Factors Affecting the Use of Red Cell Exchange	p. 412
Sickle Cell Disease and Other Hemoglobinopathies	p. 414
Protozoal Infections	p. 423
Polycythemia	p. 426
Miscellaneous Conditions	p. 426
Conclusion	p. 427
References	p. 428
Selective Extraction of Plasma Constituents	p. 437
Staphylococcal Protein A-Agarose Column	p. 440
Staphylococcal Protein A-Silica Column	p. 446
Toxicity of Staphylococcal Protein A Columns	p. 454
Selective Extraction of Low-Density Lipoproteins	p. 455
Bioartificial Liver	p. 462
Granulocyte and Monocyte Adsorption Apheresis	p. 463
Immunoadsorbers for Systemic Lupus Erythematosus	p. 463
Hemoperfusion of a Polymyxin B Column	p. 464
Selective Removal of Bile Acids	p. 464
Other Systems	p. 465
Conclusion	p. 465
References	p. 466
Therapeutic Apheresis in Pediatric Patients	p. 477
Basic Considerations	p. 477
Pediatric Apheresis Procedures	p. 481
Pediatric Diseases Treated by Therapeutic Apheresis	p. 483
References	p. 488
Clinical Features of Autologous and Allogeneic Peripheral Blood Progenitor Cell Transplantation	p. 493
Autologous Peripheral Blood Progenitor Cell Transplantation	p. 494
Allogeneic Peripheral Blood Progenitor Cell Collection and Transplantation	p. 497
Conclusion	p. 499
References	p. 500
Mobilization and Collection of Peripheral Blood Progenitor Cells	p. 503
Mobilization of Progenitor Cells	p. 503
Timing of PBPC Collection	p. 508
Harvest Schedules	p. 510
Tumor Contamination	p. 512
Collection of Stem Cells	p. 516
Summary	p. 521
References	p. 522
Apheresis for Hematopoietic Cell Processing	p. 531
ABH-Incompatible Transplants	p. 532
Mononuclear Cell Preparation Technology	p. 535
Cell Separations Using Elutriation	p. 536
Cryopreservation of Hematopoietic Progenitor Cells	p. 538
Hematopoietic Graft Quality Control	p. 539
Summary	p. 540
References	p. 541
Peripheral Blood Progenitor Cell Graft Engineering	p. 545
Sources of Hematopoietic Stem/Progenitor Cells	p. 546
Graft Manipulation	p. 547
Cell Expansion	p. 553
Conclusions	p. 555
References	p. 556
Autologous Adoptive Immunotherapy	p. 565
Cellular Therapy Overview	p. 565
Apheresis Technology in Cellular Therapies	p. 567
Autologous Adoptive Immunotherapy	p. 567
Conclusion	p. 584
References	p. 584
Allogeneic Adoptive Immunotherapy with Apheresis Products	p. 593
Graft-vs-Leukemia Effects in Murine Models of Transplantation	p. 594
Evidence for a Graft-vs-Leukemia Effect in Clinical Transplantation	p. 595
Treatment of Relapsed Leukemia after Allogeneic Transplantation: Graft-vs-Leukemia Induction with Donor Leukocyte Infusions	p. 597
Toxicity of Adoptive Immunotherapy	p. 601
New Strategies of Adoptive Immunotherapy	p. 604
Cytokine-Mediated Immunotherapy	p. 607
Nonmyeloablative Therapy and Allogeneic HPC Transplantation	p. 608
Adoptive Immunotherapy for Non-Relapse Complications After Allogeneic HPC Transplantation	p. 613
Conclusion	p. 613
References	p. 614
Photopheresis	p. 623
Collection Techniques	p. 623
Photoactivating Agents	p. 624
UVA Irradiation	p. 625
Contraindications and Side Effects	p. 626
Therapeutic Applications of Photopheresis	p. 626
Mechanism of Action of ECP	p. 636
Summary	p. 637
References	p. 638
Cellular Gene Therapy	p. 643
Basic Requirements of Gene Transfer Technology	p. 644
Desirable Properties of a Gene Delivery Vehicle	p. 645
Applications of Cellular Gene Therapy	p. 646
Regulatory and Safety Issues	p. 653
Future Prospects	p. 653
References	p. 654
Regulatory Environment for Apheresis Facilities and Personnel	p. 657
Regulatory Agencies	p. 657
Federal Legislation	p. 663
Professional Organizations	p. 665
Summary	p. 667
References	p. 667
Principles of Quality Management for Apheresis Facilities	p. 669
FDA Criteria	p. 670
AABB Criteria	p. 671
Quality System Essentials	p. 671
Conclusion	p. 679
References	p. 680
Suggested Reading	p. 680
Quality Management of Apheresis Personnel	p. 681
Background	p. 681
Employee Categories and Roles	p. 683
Management of Individuals	p. 686
Management of the Apheresis Unit	p. 687
Summary	p. 690
References	p. 690
Index	p. 691
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