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1、Plasmapheresis(P.P)腎臟科PlasmapheresisIntroductionMechanismsIndicationsComplicationsPlasmaexchangevsdouble-filtrationPPPrescribinganorderSummaryIntroductionPlasma–血漿Apheresis–分離血漿治療血漿分離術(Plasmapheresis)將血液中血球與血漿分離，以移除血漿中的有害成份血漿灌流(Plasmaperfusion)血漿(4-5%BW)血漿成份成分分子量血管內分布(%)半衰期(天)正常血中濃度(mg
2、/dl)Albumin69,00040193,500-4,500IgG180,0005021640-1430IgA150,00050630-300IgM900,00080560-350IC’>300,000------LDL-chol1,300,0001003-5140-200Plasmapheresis離心式血漿分離(Centrifugation)空心纖維膜血漿分離(Hollowfibermembrane)Plasmafiltration離心式血漿分離空心纖維膜血漿分離補充液PlasmaExchange(血漿交換術)操作情形抗凝劑移除的血漿空心纖維膜Bloodpu
3、mp補充液(血漿)Doublelumen空心纖維膜血漿分離傳統血漿交換術(PlasmaExchange)輸注他人血漿，以補充移除的血漿雙重血漿分離術(DoubleFiltrationPlasmapheresis)利用兩個人工腎臟，減少移除的血漿量血液50~100c.c/mlBPBPBP補充液去除血漿中有害成分(總血漿的10%)血漿分離器血漿成分分離器0.2μm0.03μm血球、血漿分離血漿返回雙重過濾血漿分離術M.W>160KDM.W<160KD雙重過濾血漿分離術雙重過濾血漿分離術的操作情形血漿組成成分分子量血管內分布(%)半衰期(天)正常血中濃度(mg/dl)Al
4、bumin69,00040193,500-4,500IgG180,0005021640-1430IgA150,00050630-300IgM900,00080560-350IC’>300,000------LDL-chol1,300,0001003-5140-200血漿移除量PlasmavolumeVolumenexchangedImmunoglobulinexchange(Ve/EPV)(Ve,ml)orothersubstanceremoved(MRR,%)0.51,400391.02,800631.54,200782.05,600862.57,000923.0
5、8,40095血漿補充液之選擇好處壞處白蛋白(雙重血漿分離術)較不易感染肝炎室溫保存無ABO血型考量價格昂貴不含凝血因子不含免疫球蛋白新鮮冷凍血漿(血漿交換術)含凝血因子較不易出血含免疫球蛋白較有感染肝炎,愛滋病疑慮較易發生過敏反應需ABO-血型相合生理食鹽水便宜補充量大時不適用代用血漿便宜半衰期短血漿補充量視血漿移除量多寡Plasmaexchange移除60kgx5%=3000cc血漿24UFFPDoublefiltrationplasmapheresis移除量血漿量x10%=300ccAlbumin25%50cc1bottleN/S300ccPlasmapher
6、esisIntroductionMechanismsIndicationsComplicationsP.E.vsDFPPrescribinganorderSummary治療機轉血漿移除血漿輸注可能的治療機轉 血漿移除移除血漿中可能的致病因子AntibodiesAnti-GBMAbdisease;MGImmunecomplexSLECGCryoglobulinemiaMyelomaproteinMyelomanephropathyEndotoxin,cytokineSepsisPoisonordrugCholesterol,LDL-c可能的治療機轉 血漿輸注補充血中缺
7、乏之因子Anti-thromboticorfibrinolyticfactorHUS/TTP免疫調控(Immunomodulation)RemovalofcomplementproductsSLEEffectofimmuneregulationTransplantationImprovementinREfunctionCyroglobulinemiaPlasmapheresisIntroductionMechanismsIndicationsComplicationsP.E.vsDFPPrescribinganorderSummary健保給付之適應症神經科重症肌
