Apheresis Instrumentation

Transcription

1 Apheresis Instrumentation Edwin A. Burgstaler MT, HP(ASCP) Associate Professor of Laboratory Medicine and Pathology ASFA 2016 Annual Meeting May 3, MFMER slide-1

2 Conflict of Interest Consulting:Immunocellular Therapeutics Ltd MFMER slide-2

3 Objectives Introduction Historical events Principles of operation Types of separation Selective removal Common features of apheresis equipment Maintenance & cleaning Safety Extracorporeal photopheresis Stem cell collections 2016 MFMER slide-3

4 Reference Book Principles of Apheresis Technology 5 th Edition Technical Principles of Apheresis Medicine Walter Linz, MD.MBA: Senior Editor Chapter 2: Apheresis Instrumentation Dobri D. Kiprov MD, HP (ASCP) Edwin A. Burgstaler MT,HP(ASCP) Amber P. Sanchez, MD Editor: Hans Vrielink, MD,PhD ASFA, MFMER slide-4

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14 Principles of Operation Three Steps Draw and separate the blood Remove the target component Return or replace the remaining components 2016 MFMER slide-14

15 Types of Separation Centrifugation Elutriation Filtration Combination of filtration and centrifugation 2016 MFMER slide-15

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17 CENTRIFUGATION 2016 MFMER slide-17

18 Centrifuge Apheresis Permission of Dr. Dobri Kiprov 2016 MFMER slide-18

19 Centrifugation Separation by weight (specific gravity) Can be used for cells or plasma G force defined by RPM and rotor radius Dwell time is important High viscosity can affect RBC size can affect Dual stage channels= multiple G forces Continuous flow versus intermittent flow 2016 MFMER slide-19

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27 Component Separation- TPE Ramp Outlet Plasma (low platelets) Low-G Wall Ramp Outlet Packed Red Blood Cells High-G Wall Inlet Whole Blood Platelets/White Cells G- Force 2016 MFMER slide-27

28 ELUTRIATION 2016 MFMER slide-28

29 Basic Principles of MNC Collection 1. Whole blood enters the channel 2. Blood separates in the connector 3. Buffy coat layer is pumped into the chamber 4. Platelets are returned to the patient and MNC cells are pumped into the collection bag Home Introduction Protocol Value Performance Comparison Appendix 2016 MFMER slide-29

30 2. Chamber Fills Centrifugal force Separation in the chamber Target cells accumulate in the chamber Platelets are continuously pumped back to the patient Collect pump flow rate 30 Home Introduction Protocol Value Performance Comparison Appendix 2016 MFMER slide-30

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32 FILTRATION 2016 MFMER slide-32

33 Whole Blood Air (Pressure) Plasma Cells 2016 MFMER slide-33

34 Membrane Apheresis Permission of Dr. Dobri Kiprov 2016 MFMER slide-34

35 FILTRATION & CENTRIFUGATION 2016 MFMER slide-35

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37 SELECTIVE REMOVAL THERAPY 2016 MFMER slide-37

38 Whole Blood Membrane Differential Filtration Plasma Treated Plasma 2016 MFMER slide-38

39 Blood Cell Adsorption by Adacolumn The Adacolumn is filled cellulose acetate beads that adsorb approx 50% of granulocytes and 40% of monocytes from patient s blood for each passage. The effects on RBC is minimal MFMER slide-39

40 Blood return Blood draw Adacolumn Adacolumn Adacircuit Adamonitor Venous Pressure Monitor P Air sensor Adacolumn Pump Adastand Vein Anticoagulant Port Vein Graphics courtesy of Otsuka America Pharmaceutical, Inc 2016 MFMER slide-40

41 Immunosorba PA Anticoagulation Plasma separation via centrifuge Buffer PA Eluant PA Fraction bag Waste bag Graphics courtesy of Fresenius HemoCare 2016 MFMER slide-41

42 Immunosorba PA Graphics courtesy of Fresenius HemoCare Immunoglobulins adsorbed with Staph Protein A bound to Sepharose Column regenerated with sodium citrate 0.13 M buffer at a ph of 2.2 Removes: 97% IgG1 98% IgG2 40% IgG3 77% IgG4 56% IgM 55% IgA 2016 MFMER slide-42

43 Liposorber System Graphics courtesy of Kaneka Pharma America Corporation 2016 MFMER slide-43

44 Heparin-induced Extracorporeal LDL Precipitation Graphics courtesy of B Braun MFMER slide-44

45 COMMON FEATURES of APHERESIS EQUIPMENT 2016 MFMER slide-45

46 PUMPS 2016 MFMER slide-46

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52 VALVES 2016 MFMER slide-52

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56 SENSORS 2016 MFMER slide-56

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59 SEPARATORS 2016 MFMER slide-59

60 MICROPROCESSORS 2016 MFMER slide-60

61 MAINTENACE & CLEANING 2016 MFMER slide-61

62 Maintenance Follow manufacturer recommendations Annual or semiannual PM Routine maintenance Watch for worn or damaged parts Keep the equipment clean 2016 MFMER slide-62

63 Cleaning Very important Blood, plasma, albumin, ACD-A,HES = sticky Also contaminating agents Saline is corrosive Follow manufacturer recommendations Use appropriate cleaning agents Extreme spills may require service personnel 2016 MFMER slide-63

64 SAFETY 2016 MFMER slide-64

65 Safety Follow manufacturer operating instructions Watch for hemolysis Kinked tubing Wrong fluids Hot centrifuge High TMP during filtration Prevent large spills- fluids & electricity=bad day Keep safety sensors and latches in place Prevent loose items near centrifuges 2016 MFMER slide-65

66 EXTRACORPOREAL PHOTOPHERESIS 2016 MFMER slide-66

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69 PERIPHERAL BLOOD STEM CELLS (HPC) & MNC COLLECTIONS 2016 MFMER slide-69

70 Hematopoietic Progenitor Cells Autologous Allogeneic Long procedures Mobilized patients/donors Difficult to get the specific cells Consider extra corporeal volume (ECV) Consider citrate toxicity 2016 MFMER slide-70

71 Mononuclear Cell Collections Dendritic cell collections Donor lymphocyte infusions (DLI) Research collections 2016 MFMER slide-71

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73 SUMMARY Can t do apheresis without the instruments Need operator and instrument team work to help the patient/donor Remember: the instruments are your friends 2016 MFMER slide-73