Robert Wood Johnson University Hospital
New Brunswick • Somerset

Therapeutic Apheresis at New Brunswick Campus

(732) 235-8100, extension 225 or 243

Robert Wood Johnson University Hospital, through the NBAH Blood Center, provides therapeutic apheresis to inpatients, and patients admitted for one day stay. Annually, approximately 500 procedures are performed. Ambulatory patients are admitted to same day stay under the primary attending physician who is responsible for the management of the patient's underlying disease. Critically ill and sick ambulatory and non-ambulatory patients are treated on the specific nursing floor to which they have been admitted by their physician.

Therapeutic apheresis includes: plasma exchange, red cell exchange, platelet and leukocyte depletion and photopheresis.

The therapeutic apheresis consultation and procedure is performed by Transfusion Medicine physicians, who are specialists in apheresis therapy. Hematology/Oncology fellows rotate through this program as part of their training. Prior to acceptance of the patient for the procedure a history and physical should be faxed to the donor program by the referring physician.

The patient is admitted under the service of the referring physician for a single day stay or longer depending on the nature of the disease being treated. The admitting physician should provide a history and physical, admitting diagnosis and admitting orders for the inpatient chart. The physician orders should state: To admit to referring doctor's name, diet, medications patient may take that is prescribed or brought from home. State on admitting information to Notify Transfusion Medicine attending on call for plasma exchange or Prosorba Column Apheresis. Further orders will be by Transfusion Medicine attending on call. Contact number NBAH Blood Center: (732) 235 8100 ext 225 or 243.

The transfusion medicine physician gives the orders required for the therapeutic pheresis procedure. All orders and care relevant to the patient's underlying disease if applicable for the admission are given by his/her attending physician who are familiar with the patient's medical history, drug history and other such information.

Therapeutic apheresis is a complex treatment requiring careful administration to guarantee safety and efficacy. It is performed under the supervision of a physician familiar with the operation of the equipment and with the procedure planning and calculations required to assure safety regarding patient hemodynamics vis a vis extracorporeal volume, effect on electrolytes, blood counts and coagulation parameter. Nurses who are expert at the cannulation of peripheral veins and the use of central venous access, the administration of blood and the use of the apheresis equipment perform the procedure. Patients on ACE INHIBITORS should be off the drug for 24 hours for plasma exchange to prevent serious complications during the procedure. If the patient cannot be off the drug for this period of time a non- ace inhibitor should be used for controlling hypertension

To obtain the procedure for a specific patient call NBAH donor program at (732) 235-8100 x 225 or 243 during regular working hours or on weekends call the Robert Wood Johnson University Hospital Operator at (732) 828-3000 and ask for the Hematology/Oncology fellow on call. The Transfusion Service Physician is notified and will provide consultation as to efficacy and scheduling of the procedure.

Indications for Apheresis Procedures

Thrombotic thrombocytopenic purpura (TTP)

Plasma exchange

Sickle cell crisis

Red cell exchange

Leukemia with Hyperleucocytosis

Leukapheresis

Malaria/Babesiosis(refractory to standard therapy and hemolysing) ,)

Red cell exchange

Cryoglobulinemia monoclonal (with possible occlusion of digits or impending stroke

Plasma exchange

Hyperviscocity syndrome with acute symptoms

Plasma exchange

Myasthenia gravis, crisis

Plasma exchange

Thrombocytosis, symptomatic ( over a million plt count)

Platelet depletion

Good pasture’s syndrome, acute, serious

Plasma exchange

Post transfusion purpura (definite diagnosis)

Plasma exchange

Autologous, Peripheral blood stem cell collection

HPC harvest

Anti-glomerular basement membrane antibody disease

Plasma exchange

Phytanic acid storage disease (refsum disease)

Plasma exchange

ABO mismatched marrow transplant (with severe hemolysis)

Red cell exchange

Polycythemia vera

Phlebotomy

Acute inflammatory demyelinating polyradiculneuropathy. (Guillain Barre)

Plasma exchange

Chronic inflammatory demyelinating polyradiculoneuropathy. (CIDP)

Plasma exchange

Demyelinating polyradiculneuropathy with IgG or IgA

Plasma exchange

Rapidly progressive glomerular nephritis

Plasma exchange

Cryoglobulinemia

Plasma exchange

Myeloma. Paraproteins or hyperviscocity

Plasma exchange

Myeloma with acute renal failure

Plasma exchange

Coagulation factor inhibitors

Plasma exchange

Lambert Eaton Myasthenia syndrome

Plasma exchange

Acute CNS inflammatory demyelinating disease

Plasma exchange

Polyneuropathy with IgM

Plasma exchange

Cryoglobulinemia with polyneuropathy

Plasma exchange

PANDAS (pediatric autoimmune psychiatric disorders)

Plasma exchange