ΑΙΜΑΦΑΙΡΕΣΗ ΣΤΗΝ ΚΡΙΣΗ ΚΑΡΤΑΣΗΣ ΖΑΦΕΙΡΗΣ ΑΙΜΑΤΟΛΟΓΟΣ

ΑΙΜΑΦΑΙΡΕΣΗ ΣΤΗΝ ΚΡΙΣΗ ΚΑΡΤΑΣΗΣ ΖΑΦΕΙΡΗΣ ΑΙΜΑΤΟΛΟΓΟΣ

DISCLOSURES Sorry I'm Greek

<ΚΡΙΣΗ> ΕΤΥΜΟΛΟΓΙΑ Η κρίση, κρίσις στα αρχαία, προέρχεται, από το ρήμα κρίνω, το οποίο είχε αρχική σημασία «διαχωρίζω, κοσκινίζω» και ήδη από τον Όμηρο «αποφασίζω» και αργότερα «δικάζω». Κριτήρια ήταν τα δικαστήρια ήδη από την κλασική αρχαιότητα

Η λέξη κρίσις πέρασε στα λατινικά ως crisis και από εκεί σε όλες σχεδόν τις ευρωπαϊκές γλώσσες, αλλά κυρίως με τη σημασία της επιδείνωσης μιας ασθένειας. Στις ευρωπαϊκές γλώσσες η λέξη μεταφέρθηκε και έξω από τον ιατρικό τομέα για να χαρακτηρίσει την κορύφωση μιας δύσκολης κατάστασης (για παράδειγμα, στα αγγλικά η σημασία αυτή καταγράφεται από το 1627, αναφορικά με την όξυνση στις σχέσεις Κοινοβουλίου και βασιλιά) και έτσι επέστρεψε και στα ελληνικά, σαν ένα είδος σημασιολογικού αντιδάνειου, για να μας παιδεύει.

Αιμαφαίρεση Ετυμολογία Αιμαφαίρεση= αίμα αφαίρεση Αίμα / αἴθω = καίω, ανάπτω, θερμαίνω Εκ του παθητικού παρακ. ᾖσμαι αἴσμα αἷμα Αφαίρεση = από +αἱρεω-ϖ (συλλαμβάνω, κυριεύω)

Αιμαφαίρεση είναι η διαδικασία απομάκρυνσης ειδικών ουσιών από το αίμα ενός δότη ή ασθενούς που περιέχει στοιχεία που προκαλούν ασθένειες. Είδη αιμαφαίρεσης είναι Πλασμαφαίρεση Λευκαφαίρεση Λεμφοαφαίρεση Ερυθροαφαίρεση Αιμοπεταλιοαφαίρεση. Η αιμαφαίρεση χρησιμοποιείται σε πληθώρα ασθενειών και καταστάσεων.

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ΟΙΚΟΝΟΜΙΚΗ ΚΡΙΣΗ

ΑΙΜΑΦΑΙΡΕΣΗ ΠΡΟ ΚΑΙ ΚΑΤΑ ΤΗ ΔΙΑΡΚΕΙΑ ΤΗΣ ΚΡΙΣΗΣ

Σύνολο Αιμοπεταλιαφαιρέσεων 2006 2007 2008 2010 2011 2012 2013 10.580 13.798 15.636 8.120 7.919 9877 11885

Συλλογή PBSC για Αυτόλογη ΜΜΟ 2006 2007 2008 2010 2011 2012 2013 497 481 462 327 320 327 272

Εκλεκτική Πλασμαφαίρεση ΕΙΔΟΣ 2006 2007 2008 2010 2011 2012 2013 ΛΙΠΙΔΙΟΑΦΑΙΡΕΣΗ 143 284 116 99 ΑΝΟΣΟΠΡΟΣΡΟΦΗΣΗ 42 260 264 73 ΔΙΠΛΗ ΔΙΗΘΗΣΗ 21 51 114 ΣΥΝΟΛΟ 185 281 599 303 99 261 261

Φωταφαίρεση ΝΟΣΟΚΟΜΕΙΑ 2006 2007 2008 2010 2011 2012 2013 ΠΑΠΑΝΙΚΟΛΑΟΥ 280 290 280 118 136 ΑΤΤΙΚΟΝ 34 218 24 0 0 ΝΠ ΑΓ.ΣΟΦΙΑ 42 50 21 23 0 ΣΥΝΟΛΟ 356 558 325 141 136 136 73

FARMASERV-LILLY 198 RONTIS E &E 220-280 ALAPIS MEDICON

Τιμή set αιμοπεταλειαφαίρεσης στην κρίση 50-100 ελάττωση της τιμής σε σύγκριση με τις τιμές προ κρίσης/set

ΤΙ ΠΡΕΠΕΙ ΝΑ ΓΙΝΕΙ

ΑΚΟΛΟΥΘΟΥΜΕ ΤΙΣ ΔΙΕΘΝΕΙΣ ΚΑΤΕΥΘΥΝΤΗΡΙΕΣ ΓΡΑΜΜΕΣ

Hemapheresis Guidelines Medical University of South Carolina Hospital Hemapheresis Unit 2006 Erni Moore, RN, HP (ASCP) 2013 Administrative Coordinator/Manager

GENERAL THERAPEUTIC CATEGORIES The American Society for Apheresis (ASFA) guidelines for therapeutic plasma exchange (TPE) are based on extensive literature reviews of TPE for multiple disease states These guidelines are generally updated every two or three years. Conditions are divided into the following four categories, based on evidence of clinical efficacy of TPE reported in peer-reviewed literature; a more comprehensive listing of conditions according to category is presented in the table :

At least one of the following conditions must be present for TPE to be a rational therapeutic choice: The substance to be removed should be sufficiently large (molecular weight greater than 15,000) so that it cannot be easily removed by less expensive purification techniques such as hemofiltration or high-flux hemodialysis. The substance to be removed must have a sufficiently long half-life, so that extracorporeal removal is much more rapid than endogenous clearance pathways. The substance to be removed must be acutely toxic and/or resistant to conventional therapy, so that the rapid elimination from the extracellular fluid by TPE is indicated.

exchange (TPE) are based on extensive literature reviews of TPE GENERAL THERAPEUTIC CATEGORIES The American Society for Apheresis (ASFA) guidelines for therapeutic plasma for multiple disease states These guidelines are generally updated every two or three years. Conditions are divided into the following four categories, based on evidence of clinical efficacy of TPE reported in peer-reviewed literature; a more comprehensive listing of conditions according to category is presented in the table :

Category I Disorders for which apheresis is accepted as first-line therapy, either as primary stand-alone treatment or in conjunction with other modes of treatment. Examples: Plasma exchange in Guillain-Barré syndrome as first-line stand alone therapy. Plasma exchange for hyperviscosity in monoclonal gammopathies. Plasma exchange in thrombotic thrombocytopenic purpura. Red blood cell exchange (ie, exchange transfusion) in sickle cell disease for the management of acute stroke.

Category II Disorders for which apheresis is accepted as second-line therapy, either as a stand-alone treatment or in conjunction with other modes of treatment. Examples: Plasma exchange as stand-alone secondary treatment for acute disseminated encephalomyelitis after high-dose intravenous corticosteroid failure. Plasma exchange for life-threatening cold agglutinin disease. Red blood cell exchange for acute chest syndrome in sickle cell disease.

Category III Disorders for which the optimum role of apheresis therapy is not established. Decision making should be individualized. Examples: Extracorporeal photopheresis for nephrogenic systemic fibrosis; Plasma exchange in patients with sepsis and multiorgan failure. Plasma exchange for hypertriglyceridemic pancreatitis.

Category IV Disorders for which published evidence demonstrates or suggests apheresis to be ineffective or harmful. Institutional review board (IRB) approval is desirable if apheresis treatment is undertaken in these circumstances. Examples: Plasma exchange for active rheumatoid arthritis. Plasma exchange for pemphigus vulgaris.

THERAPEUTIC APHERESIS INDICATION CATEGORIES ENDORSED BY ASFA AND AABB (Clinical Efficacy) CATEGORY I. Standard and acceptable as primary or first line adjunctive. Clinical Trials. CATEGORY II. Generally accepted as supportive therapy. CATEGORY III. Represent heroic or last-ditch efforts. Insufficient evidence or conflicting results to document indication. NOT clearly indicated. CATEGORY IV. Lack of efficacy. Clinical application only under approved research protocol.

GUIDELINES FOR WHEN TO PERFORM APHERESIS PROCEDURES: Emergent: 24hours/7days a week Urgent: Routine: Weekends and holidays during day hours; or extending week day hours past the usual hours of operation Scheduled during routine hours of operation 0800 to 1600

EMERGENT PROCEDURES TTP Category I Acute Chest Syndrome (Sickle Cell) CVA 2º Sickle Cell Crisis CML; Leukostasis & BLASTS >50,000 AML; Leukostasis & BLASTS >50,000 AML; Asymptomatic & BLASTS>100K Myeloproliferative disorder with bleeding ALL (Primarily in pediatric population) Coagulopathy 2º Liver Failure Prior to transplant surgery Category I Category I Category I Category I Category I Category I Category II Category III

URGENT PROCEDURES Disorders/Conditions treated Urgently: Acute Myasthenia Gravis Crisis, 1st treatment Category I Guillain Barré Syndrome (Acute), 1st treatment Category I TTP, after 1st emergent treatment Priapism in Sickle Cell Crisis CML; Asymptomatic & BLASTS > 100,000 Wegener s granulomatosis Category I Category I Category I Category I Goodpasture s Syndrome, 1st treatment Pulmonary Hemorrhage Renal Insult Category I Category Ι

URGENT PROCEDURES, continued Multiple Myeloma/hyperviscosity Symptomatic Category II Myeloma Kidney with renal failure Category II Waldenstrom s; Symptomatic Category II Rapidly progressive glomerulonephritis Category II Heart Transplant Rejection (1st treatment) Should be scheduled routine hours of operation Category III Preparatory for Special Procedure in Liver failure Category III Kidney Transplant Rejection -1 treatment Category IV* * Should be undertaken only under an approved research protocol.

PROCEDURES: MONDAY THROUGH FRIDAY, DAY HOURS 08.00 TO 16.00 ROUTINE Hematopoietic Peripheral Cells (BMT) Category I Myasthenia Gravis, after 1st treatment Category I CIDP Category I Category I Guillain Barré, (GBS) after 1st Treatment Category I Miller Fisher Variant GBS Category I RBC Exchange for Prophylaxis Category I Category I Demyelinating Polyneuropathy w/ IgG and IgA Category I Polycythemia Vera (Therapeutic Phlebotomy) Category I Porphyria Cutanea Tarda-Therapeutic Phlebotomy Category I Hemachromatosis (Therapeutic Phlebotomy) Category I Eisenmenger s (Therapeutic Phlebotomy) Category I

ROUTINE PROCEDURES: Monday through Friday, Day hours 0800 to 1600 Hemolytic Uremic Syndrome Focal Segmenting Glomerulosclerosis Kidney Transplant Sensitization Multiple Sclerosis Paraneoplastic Neurologic Syndrome Vasculitis Kidney Transplant Rejection Systemic Lupus Erythematosis/nephritis Category III Category III Category III Category III Category III Category III Category IV* Category IV* *Should be undertaken only under an approved research protocol.

ROUTINE PROCEDURES: Monday through Friday, day hours 08.00 to 16.00 Taper regimen or Chronic TTP Transverse Myelitis Eaton-Lambert MyastheniaSyndrome Polyneuropathy with IgM Cryoglobulinemia w/ neuropathy Waldenstrom s, after 1st treatment Glomerulonephritis, progressive Cryoglobulinemia Multiple myeloma w/ neuropathy Category I Category II Category II Category II Category II Category II Category II Category II Category III

ΥΠΕΡΑΣΠΙΖΟΜΑΣΤΕ ΣΘΕΝΑΡΑ Αιμαφαίρεση σε ενδείξεις που πηγάζουν από κατευθυντήριες γραμμές Διεθνώς παραδεκτές( CATEGORY I, II) Επιχειρούμε αιμαφαίρεση εκτός απόλυτων ενδείξεων στα πλαίσια ηρωικής προσπάθειας να σωθεί ανθρώπινη ζωή (CATEGORY ΙΙΙ ) ΑΠΟΦΕΥΓΟΥΜΕ αιμαφαίρεση ή επιχειρούμε στα πλαίσια ΕΓΚΕΚΡΙΜΕΝΩΝ κλινικών μελετών (CATEGORY IV.)

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