الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Since antiquity, mankind has hypothesized there are bad substances called “humors” that accumulate in the blood of sick patients and that the removal of these humors would make patients feel better. Bloodletting, the practice of draining blood from sick patients, has been around since the Egyptians, dating back 1000 years BC. The practice of bloodletting peaked in the 18th century and evolves with modern technology to this day. Apheresis from the Greek means ”to remove” or ”to take away”. In 1979, Lockwood and his colleague and Jones and his coworkers first described the therapeutic use of plasmapheresis in systemic lupus erythematosus and other autoimmune diseases.
Plasmapheresis is a separation process to remove plasma from whole blood. Plasmapheresis treatments are usually applied to patients who have failed in other standard therapies. Therapeutic apheresis (TA) refers to an extracorporeal procedure in which blood separator technology is used to remove abnormal blood cells and plasma constituents. The terms plasmapheresis, leukocytapheresis, erythrocytapheresis, and thrombocytapheresis describe the specific blood element that is removed.
Plasmapheresis is performed by 2 fundamentally different techniques: centrifugation or filtration. With centrifugation apheresis, whole blood is spun so that the 4 majorblood components are separated out into layers by their different densities. With filtration plasmapheresis, whole blood passes through a filter to separate the plasma components from the larger cellular components of red blood cells, white blood cells, and platelets. Centrifugation apheresis is commonly performed by blood bankers. Primary membrane plasma separation plasmapheresis was introduced in 1978 as a new method for performing therapeutic plasma exchange. Both centrifugationand membraneplasmapheresis require anticoagulation The most frequently used anticoagulant for centrifugation procedures is citrate. A. continuous infusion of acid-citrate dextrose (ACD) is given intravenously. Heparin is most frequently used anticoagulant for membrane plasmapheresis approximately twice the dose of is that needed for hemodialysis.
Erythrocytapheresis (RBC exchange) is a therapeutic procedure in which blood of the patient is passed through a medical device which separates red blood cells from other components of blood, the red blood cells are removed and replaced with either donor red blood cells alone and/or colloid solution. Erythrocytapheresis is a safe, simple and efficient method for lowering the HbS level quickly .This technique, which has been used primarily for the prevention or management of acute, severe complications of sickle cell disease, may also be a safe, simple, and efficient method for reducing iron accumulation during long-term transfusion therapy.
When the white blood cells (e.g., leukemic blasts or granulocytes) are separated by the apheresis procedure, it is called leukocytapheresis (LCP). These selected cells are collected and the remainder of the patient’s or the donor’s blood is returned with or without addition of replacement fluid such as colloid and/or crystalloid solution. This procedure can be used therapeutically or in preparation of blood components.
Also the platelets can be separated out of blood by the apheresis procedure. This can be used either for collecting the platelets from the donor’s blood in the preparation of blood components (e.g., apheresis platelets); this is called plateletapheresisor for removing the platelets from the patient’s blood for therapeutic purpose; this is called thrombocytapheresis. Thrombocytapheresisused in the treatment of thrombocytosis and is reserved for patients with acute cerebrovascular complications or digital ischemia, since rapid reduction of the platelet count and symptomatic relief are required.
Extracorporeal photopheresis (ECP) is a therapeutic procedure in which a buffy coat, separated from patient’s blood, is treated extracorporeally and subsequently reinfused to the patient during the same procedure.ECP is based on the infusion of autologous peripheral blood mononuclear cells collected by apheresis, incubated with the photoactivable drug 8-methoxypsoralen (8-MOP) and ultraviolet-A (UV-A) irradiation .ECP is currently being used for the treatment of cutaneous T-cell lymphoma, selected autoimmune diseases, and rejection after solid organ transplantation.
There is many indication for Plasma pheresisincluding myasthenia gravis, primary macroglobulinemia, thromobotic thrombocytopenic purpura, Goodpasture syndrome, glomerulonephritis, Guillain-Barre syndrome, life-threatening systemic lupus erythematosus when conventional therapy has failed, life-threatening rheumatoid vasculitis and life-threatening scleroderma and polymyositis when the patient is unresponsive to conventional therapy.
One of the commonest complications during the procedure is a decrease in blood calcium concentration., which may result in symptoms of tetany, Anaphylactic reactions, sepsis, Haemorrhagic complications as thrombocytopenia and may also result from anticoagulation used (heparin, citrate) and manifest themselves as (bleeding from the site of catheter placement or from nasal mucosa, haematemsis or coughing up of bloody bronchial secretion) and Complications related to central vein cannulation are typical of this procedure and include pneumothorax, air embolus, injection site haemotoma, infection, and venous thrombosis.