Baxter International Inc. · NYSE:BAX
Baxter International — Technical Presentation (June 2020)
18 slides from Baxter International's technical presentation, June 2020
Slide 1: Therapeutic Plasma Exchange Part I: Methods, Goals & Guidelines
Therapeutic Plasma Exchange Part I: Methods, Goals & Guidelines Tena Griffin, DNP, CRNP Renal Clinical Educator Baxter Healthcare
Slide 2: Overview
Overview • Therapeutic apheresis overview • Comparing apheresis methods • Goals of therapeutic apheresis • Indications/guidelines/disease categories USMP/MG120/19-0022 09/19 2
Slide 3: Definition of Apheresis
Definition of Apheresis Apheresis: Derived from the Greek word “aphaeresis,” meaning “to separate,” “to take away by force,” or “to remove” Apheresis is the process where plasma or cellular components are separated from the circulating whole blood and the remainder is returned to the patient/donor W
Slide 4: Apheresis Categories
Apheresis Categories Apheresis is performed in two capacities: • Donor: Extracorporeal removal of whole blood from a donor who is supplying one or more blood components • Therapeutic: Extracorporeal removal of plasma or cellular components from a patient to remove or treat abnormal/diseased componen
Slide 5: Therapeutic Apheresis Overview
Therapeutic Apheresis Overview Gambro. Introduction to Therapeutic Plasma Exchange. Renal Intensive Care – Self-learning Module (Version 2). 2004. USMP/MG120/19-0022 09/19 5
Slide 6: Apheresis Technologies
Apheresis Technologies Therapeutic apheresis can be performed using a variety of collection methods The two most common methods are:1,2 Centrifugation: Centrifuge devices are more common worldwide (with the exception of Japan and Germany) and are the most widely used devices in the United States2 Me
Slide 7: Centrifugation
Centrifugation • A system draws whole blood from a donor patient, adds anticoagulant, separates the blood components, collects or removes specific components, and returns uncollected components back to the donor patient • Separates blood components based on specific gravity (density) rather than mol
Slide 8: Membrane Filtration/Plasmafiltration
Membrane Filtration/Plasmafiltration • Plasma is removed from the patient’s blood by filtration across a plasma filter membrane and replaced with fresh plasma or a protein solution post-filter • Blood components are separated based on molecular size using convection • Limited to removal of plasma; n
Slide 9: Comparing Apheresis Methods
Comparing Apheresis Methods Characteristic Centrifuge Membrane Mechanism Centrifugal force Capillary membrane filter 10-150 100-250, 150 average Blood flow, mL/min (potential peripheral access) (requires central access) Plasma extraction, % 80 30 Plasma removal, mL/min Variable 30 Anticoagulation Ci
Slide 10: Goals of Therapeutic Apheresis
Goals of Therapeutic Apheresis • Removal of antibodies • Removal of immune complexes • Removal of plasma constituents • Replacement of plasma deficiencies Kiprov DD, et al. in Daugirdas JT et al. (Eds.) Handbook of Dialysis 5th edition, 2015 (pp 323–348). USMP/MG120/19-0022 09/19 10
Slide 11: Indications / ASFA Guidelines
Indications / ASFA Guidelines The most comprehensive guidelines for therapeutic apheresis are published by the American Society for Apheresis (AFSA) • TPE can be used to treat a variety of disease states, both acute and chronic, that are fully outlined in the ASFA guidelines • Treatment is based on
Slide 12: ASFA Categories
ASFA Categories Category I Disorders for which apheresis is accepted as first-line therapy, either as a primary stand-alone treatment or in conjunction with other modes of treatment Category II Disorders for which apheresis is accepted as second-line therapy, either as a stand-alone treatment or in
Slide 13: AFSA Category Examples
AFSA Category Examples Category I • Guillain-Barre syndrome • Thrombotic thrombocytopenia purpura (TTP) • Myasthenia gravis • Goodpasture syndrome Category II • Cryoglobulinemia • Multiple sclerosis (acute attack, relapse) • ABO transplant incompatibility Category III • Heparin-induced thrombocytope
Slide 14: TPE Selection Criteria
TPE Selection Criteria One or more of the following conditions should be met: • Targeted substance is >15,000 Datons • Targeted substance has a relatively long half-life, so that removal provides a therapeutically useful period of diminished serum concentration • Targeted substance is acutely toxic
Slide 15: Typical Solute Molecular Weights
Typical Solute Molecular Weights Substance Molecular weight in Daltons (1 d. = 1/16th H+ atom) Albumin 69,000 IgG 180,000 IgA 150,000 IgM 900,000 LDL-cholesterol (LDL apheresis) 1,300,000 Kiprov DD, et al. in Daugirdas JT et al. (Eds.) Handbook of Dialysis 5th edition, 2015 (pp 323–348). USMP/MG120/
Slide 16: Knowledge Check
Knowledge Check • Can you discuss basic TPE terms and principles? • Can you differentiate between centrifuge and membrane TPE? • Can you identify the common TPE therapeutic goals and associated disease states? Please refer to your facility's protocols before performing this treatment. USMP/MG120/19-
Slide 17: References
References USMP/MG120/19-0022 09/19
Slide 18: References
References • Gambro. Introduction to Therapeutic Plasma Exchange. Renal Intensive Care – Self-learning Moduler (Version 2). 2004. • Gambro. Prismaflex Operator’s Manual (for use with software versions 7.xx). Order Number G5039110. 2005-2014. • Gashti CN. Membrane-based Therapeutic Plasma Exchange: A
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