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Automated Collection of Blood Products 19 CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 2 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC AUTOMATEDNOT FOR SALE OR DISTRIBUTION COLLECTIONNOT FOR SALE OR DISTRIBUTION OF BLOOD PRODUCTS © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SUSAN M. CONNOR © Jones & Bartlett Learning, LLC © Jones &pheresis Bartlettmeans Learning, “to remove” LLC and heme refers to NOT FOR SALEOBJECTIVES OR DISTRIBUTION NOT FORA “blood.” SALE ORIn hemapheresis DISTRIBUTION, whole blood is re- moved from a donor or patient and separated into After completion of this chapter, the reader will be able to: components. One or more of the components is re- tained, with the remaining portion recombined and 1. Explain what the term “apheresis” means. returned to the donor or patient. This technology has 2. Describe the history© Jones of hemapheresis. & Bartlett Learning, LLCmade it possible to just select© Jones the component & Bartlett needed Learning, LLC 3. Explain separationNOT by centrifugation. FOR SALE OR DISTRIBUTIONor to automate the productionNOT FOR of multiple SALE compo-OR DISTRIBUTION 4. Discuss the various apheresis technologies available and nents. Blood cells, platelets, plasma, and/or granu - the basic principles of separation for each technology. locytes may be collected using automated blood collection devices based on apheresis technology. 5. Explain separation by membrane filtration. Apheresis is also used as a treatment modality. 6.© ExplainJones separation & Bartlett by adsorption. Learning, LLC Although© there Jones are difficulties& Bartlett in Learning, the documentation LLC 7.NOTList the FOR components SALE thatOR may DISTRIBUTION be collected by apheresis. of benefit,NOT there FORis general SALE agreement OR DISTRIBUTION that therapeutic 8. Discuss the role of apheresis in therapeutic applications. apheresis is effective treatment for certain disease conditions. The following is a list of diseases that are 9. List the types of therapeutic cytapheresis procedures treated by therapeutic apheresis:1,2 that can be performed. © Jones & Bartlett10. Discuss Learning, the diseases LLCthat are treated by therapeutic© Jones •& Hematology/oncologyBartlett Learning, conditionsLLC apheresis. • Paraproteinemias NOT FOR SALE OR DISTRIBUTION NOT FOR• SALE Hyperleukocytosis OR DISTRIBUTION • Thrombocythemia KEY WORDS • Thrombotic thrombocytopenic purpura/ hemolytic uremic syndrome Apheresis © JonesMembrane & Bartlett filtration Learning, LLC • Sickle cell disease © Jones & Bartlett Learning, LLC Erythrocytapheresis Plasmapheresis • Posttransfusion purpura NOT FOR SALE OR DISTRIBUTION• Neurology conditionsNOT FOR SALE OR DISTRIBUTION Hemapheresis Plateletpheresis • Acute Guillain–Barré syndrome Hematopoietic progenitor Surge • Chronic inflammatory polyneuropathy cells Therapeutic apheresis • Myasthenia gravis Immunoadsorption© Jones & Bartlett Learning,Thromocytapheresis LLC • Cryoglobulinemia© Jones & Bartlett Learning, LLC Leukapheresis • Rapidly progressive glomerulonephritis associ- NOT FOR SALE OR DISTRIBUTION atedNOT with FOR antibody SALE to neutrophilOR DISTRIBUTION cytoplasmic Lymphocytapheresis antigen • Homozygous type II familial hypercholes- terolemia © Jones & Bartlett Learning, LLC © Jones •& RefsumBartlett di seaseLearning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 17 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 18 UNIT 1 Blood and Blood Components © Jones BRIEF& Bartlett HISTORY Learning, ON LLCTHE © Jonesand the & same Bartlett venous Learning, access line is LLC used for both with- NOT FORSEPARATION SALE OR DISTRIBUTION OF BLOOD NOTdrawal FOR and SALE return OR of theDISTRIBUTION blood. In the continuous-flow method, two venous access sites are used. One access Throughout history, blood has been seen as a crucial site is used for removal of the whole blood from the element of disease and health. In the past, the practice donor or patient and the other site is used for return of of eliminating disease or unwanted elements was the “unwanted” portion back to the donor. Some instru- © Jones & Bartlett Learning, mentsLLC can be used in either continuous-© Jones or & intermittent- Bartlett Learning, LLC accomplished by bloodletting.NOT FOR This SALE was ORused DISTRIBUTION as a NOT FOR SALE OR DISTRIBUTION therapeutic technique for many centuries and is still flow mode. sometimes used today. The practice of bloodletting All automated separation devices require eventually led to plasmapheresis, first described by prepackaged sets of sterile bags, tubing, and centrifugal Abel and coworkers in 1914. This was followed devices. Most of these are specifically designed for use by donor and therapeutic hemapheresis, which later on instruments of a particular manufacturer. © Jones & Bartlett Learning, LLC The IBM ©2997 Jones cell separator, & Bartlett which Learning,was a continuous- LLC combinedNOT centrifugal FOR SALE force OR technology DISTRIBUTION to fractionate on NOT FOR SALE OR DISTRIBUTION a much larger scale. The use of centrifugal force flow machine, set a high standard for low cross- marked the beginning of semiautomated, large-scale contamination when the instrument was introduced in plasmapheresis of donors for the collection of plasma. the late 1970s. It also offered a shorter procedure time The development of sterile plastic containers later than existing technology. This technology has now been allowed manual separation of plasma from whole replaced with systems that automate the procedure, fur- © Jones & Bartlett Learning, LLC © Jonesther reduce & Bartlett cross-cellular Learning, contamination, LLC and enhance NOT FORblood SALE using OR a seriesDISTRIBUTION of interconnected disposable bags.NOT FOR SALE OR DISTRIBUTION This system allowed separation of platelets, the first efficiency. The first automated cell separation device to cellular element harvested by apheresis. Up to this use a closed system for platelet storage (CS-3000) was time, all procedures were manual because automated introduced in the 1980s by the Fenwal Division, Baxter 3 systems were not available. In the late 1950s and early Healthcare Corporation (Deerfield, IL). 1960s, two centrifugation© Jones systems & were Bartlett developed Learning, that LLC © Jones & Bartlett Learning, LLC permitted, for the firstNOT time, FORthe automated SALE OR harvesting DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of granulocytes, platelets, and plasma. In addition, BOWL TECHNOLOGY therapeutic plasmapheresis and cytapheresis, the re- moval of cellular elements, became a means of direct The separation technology based on the work of therapeutic treatment. In recent years, the refinements Dr. Jack Latham uses a disposable bowl with a rotating and improvements made to centrifugation technology, seal and discontinuous flow. The blood to be processed © Jones & Bartlett Learning, LLC enters the bowl© Jones through & theBartlett inlet port Learning, and feed tubeLLC includingNOT additional FOR SALE automation, OR DISTRIBUTION have increased safety NOT FOR SALE OR DISTRIBUTION to the donor, reduced time to perform the procedures, (Fig. 2-1). When the blood meets the base of the bowl, it and improved yields for component collections. is redirected to the angular velocity of the bowl. Cen- trifugal force causes the blood to migrate out to the space between the body and the outer core, which is SEPARATION BY CENTRIFUGATION the separation chamber. It is here, in the separation © Jones &(INTERMITTENT Bartlett Learning, OR LLC CONTINUOUS © Joneschamber & thatBartlett the blood Learning, separates LLCinto its components. NOT FORFLOW) SALE OR DISTRIBUTION NOTThe FOR plasma SALE is forced OR out DISTRIBUTION of the separation chamber and into the upper assembly from which it enters the efflu- Many automated collection devices use centrifugal ent tube. The plasma leaves the bowl through the effluent force to separate the blood into its various components. tube and outlet port and goes into the effluent line. Separation is based on the differences in component Platelets and white blood cells follow, leaving the red density. A controlled amount© Jones of anticoagulant & Bartlett Learning,solution blood LLC cells (RBCs) in the bowl.© JonesRBCs and & Bartlettplasma are Learning, LLC is added to the wholeNOT blood FOR as it SALEis drawn OR from DISTRIBUTION the then returned separately throughNOT a reinfusionFOR SALE bag. OR DISTRIBUTION donor. This mixture of anticoagulant and blood is then A technology known as “surge” was introduced pumped into a rotating bowl, chamber, or tubular by the Haemonetics Corporation (Braintree, MA). rotor, and it is here that the whole blood is separated “Surge” is a Haemonetics term for the elutriation into layers of components based on each component’s (washing) of platelets away from the buffy coat. In density.© Jones In component & Bartlett harvest, Learning, the desired LLC layer of surge technology,© Jones plasma & Bartlett is recirculated Learning, through LLC the componentNOT FOR is collected SALE and OR the DISTRIBUTION remaining portions of bowl at a high-enoughNOT FOR velocitySALE ORto pull DISTRIBUTION platelets out the blood are returned to the donor. but leave white and RBCs behind. This potentially Automated centrifugal separation of blood compo- increases platelet yields and reduces white blood cell nents is performed by either
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