Question | Answer |
When a tube of blood is centrifuged, the components separate in order of increasing specific gravity: list top to bottom | plasma, platelets, lymphocytes and monocytes, granulocytes, RBCs |
Typical preset ratio for anticoagulant solution in apheresis | 10-14 parts of whole blood to 1 part of citrate Anti-coagulant |
Which is more commonly used for apheresis procedures: A. centrifugation B. filtration | A. centrifugation |
The most commonly performed therapeutic apheresis procedure | TPE: therapeutic plasma exchange |
What % of IgM is removed with a 1 volume TPE? | 70%; IgG is less |
Increased muscle mass effects total blood volume in this way | increases |
obesity effects total blood volume in this way | decreases |
formula for estimating total blood volume | 70ml/kg in males; 65 ml/kg in females |
The general standard of care is to limit the extracorporeal blood volume during an apheresis procedure to this % | 15% |
for TPE, avoid using plasma unless: 1._ 2._ 3._ | 1. plasma is specifically indicated to treat disease(TTP)
2. plasma is required to correct a coagulation factor
3. plasma is needed to prevent dilutional coagulopathy in actively bleeding patient (pulmonary renal syndrome) |
When a patient needs dialysis and apheresis the same day, which should be done first? Why? | apheresis because possible hypotension |
anticoagulant of choice in apheresis | citrate |
how does citrate work as an anticoagulant | binds calcium. blocks calcium dependent platelet activation and clotting factor reactions |
Patients with dysfunction in this organ are more prone to citrate reactions in apheresis | liver |
The single greatest risk factor for adverse events associated with therapeutic apheresis | central venous catheter |
Apheresis effect on PT and PTT | increases |
This coagulation protein should be assessed regularly in TPE patients | fibrinogen |
The rate of adverse events during therapeutic apheresis is _% | 5% (up to 33% if you count mild perioral tingling,etc) |
Most common symptoms of citrate reactions | perioral tingling and peripheral parethesias |
treatments for citrate reactions | lower rate.
Chewable calcium tabs
IV calcium gluconate |
The most common reaction seen with whole blood donation | vasovagal reaction |
Treatment of air embolism | place patient on left side in Tredenlenberg position so air will go to apex of right ventricle. Then air will dissolve into bloodstream |