36515 Therapeutic apheresis; with extracorporeal immunoadsorption and plasma reinfusion

Name of the Procedure:

Therapeutic Apheresis; Extracorporeal Immunoadsorption and Plasma Reinfusion

Summary

Therapeutic apheresis with extracorporeal immunoadsorption and plasma reinfusion is a medical procedure where blood is filtered outside the body to remove harmful components. The purified blood is then returned to the body. This technique specifically targets certain antibodies or proteins that contribute to various diseases.

Purpose

This procedure is typically used to treat autoimmune diseases, neurological disorders, and other conditions where harmful antibodies or proteins need to be removed from the blood. The goal is to reduce disease-related symptoms and improve the patient's quality of life by eliminating harmful substances from the bloodstream.

Indications

• Autoimmune diseases (e.g., myasthenia gravis, systemic lupus erythematosus)
• Neurological disorders (e.g., Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy)
• Certain kidney conditions (e.g., Goodpasture's syndrome, certain forms of glomerulonephritis)
• Patients who have not adequately responded to conventional therapies

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments may be necessary, especially for anticoagulants.
• Blood tests and assessments to determine overall health and suitability for the procedure are often required.

Procedure Description

1. Initial Setup: The patient is connected to an apheresis machine via intravenous (IV) lines, usually in both arms.
2. Blood Withdrawal: Blood is drawn from the patient and passed through the apheresis machine.
3. Filtration and Adsorption: The machine separates plasma from the blood components. The plasma passes through an immunoadsorption column that removes specific antibodies or proteins.
4. Plasma Reinfusion: The filtered plasma is then mixed back with the blood cells and returned to the patient. In some cases, replacement fluids, such as saline or albumin, are used.
5. Monitoring: Throughout the procedure, the patient's vital signs are closely monitored.

Tools and Equipment:

• Apheresis machine
• Immunoadsorption columns
• IV lines and cannulas

Anesthesia or Sedation:

• Local anesthesia may be used at the IV insertion sites.

Duration

The procedure typically takes 2 to 4 hours to complete.

Setting

Therapeutic apheresis is performed in a hospital, outpatient clinic, or specialized treatment center.

Personnel

• Trained apheresis nurses
• Hematologists or nephrologists
• Technicians specialized in operating apheresis machines

Risks and Complications

• Common risks: Mild bleeding or bruising at IV sites, hypotension (low blood pressure), electrolyte imbalances.
• Rare risks: Infection at IV sites, allergic reactions to anticoagulants, severe hypotension, or clotting issues.

Benefits

• Reduction in disease symptoms due to the removal of harmful antibodies or proteins.
• Improvement in overall health and function.
• Benefits can often be noticed within days to weeks.

Recovery

• Post-procedure monitoring for several hours to ensure stability.
• Patients are usually advised to rest and avoid strenuous activities for 24 hours.
• Follow-up appointments are necessary for further treatment and assessments.

Alternatives

• Medication management (e.g., immunosuppressants, steroids)
• Other types of apheresis, such as plasma exchange (plasmapheresis)
• Each alternative has its own benefits and risks, often depending on the specific condition being treated.

Patient Experience

• Some patients may feel light-headed or tired during and after the procedure.
• Discomfort is usually minimal, primarily related to the IV insertion.
• Pain management and comfort measures include local anesthesia and supportive care throughout the procedure.