Therapeutic Pheresis A Resident’s Guide治疗单采居民的指南.pptVIP

Therapeutic Pheresis: A Resident’s Guide Lloyd Cook, MD James Fulcher, MD Examples of “Evil Humors” Separation Method Apheresis Machines are basically centrifuges that can move a certain part of the blood based on density. The assorted tubes and pumps are there to maintain proper flow into/from the body. Apheresis Setup for RBC Exchange in S.C. Crisis Plasma Exchange with 5% albumin for M.G. Final procedural point: Choice of solute depends on disease treated TTP/HUS- FFP-allergy/infection risk worth replacing vital clotting factors Guillain Barré- 5% albumin- reduce infection/allergy risk Myasthenia Gravis- 5% albumin- reduce infection/allergy risk Indications/ Link to Insurance Website TTP- plasma Guillain Barré- plasma Myasthenia Gravis- plasma Leukocytosis- Cytapheresis Sickle Cell- Red cell exchange Multiple autoimmune neuropathies Atena Policy on Apheresis Review of the Diseases Commonly Treated by ApheresisDiscussion will follow in this order TTP/HUS Guillain-Barre Myasthenia Gravis Eli Moschcowitz (1879-1964) “In hospitals, people should be treated and not diseases.” Thrombotic thrombocytopenic purpura Thrombotic thrombocytopenic purpuraDemographics Incidence: 1:100,000 - 1:500,000 Male:female 1:2 Age Most common in 30-40 year olds 90% of patients less than 60 years old No racial differences No seasonal difference Thrombotic Thrombocytopenic Purpura Clinical findings Fever Neurological changes Renal impairment Laboratory findings Microangiopathic hemolytic anemia Thrombocytopenia Laboratory Findings in TTP Thrombocytopenia 20,000/μl Anemia 10g/dl Reticulocytosis LDH increased Indirect/direct bilirubin increased (depends on liver function) Haptoglobin deceased Defining the diagnosis of TTP Anemia may not be apparent at diagnosis Alternative diagnoses may only be apparent after treatment has begun The initial diagnosis should be considered tentative Remain vigilant for an alternative diagnosis MCG recently had a case of “TTP” that was mo