Pheresis

The term 'Pheresis' is of Greek origin and it means 'to take away' or 'separate'. Pheresis is a special kind of blood donation. The specific components of blood namely the plasma, erythrocytes, platelets, granulocytes, agranulocytes are separated. In this procedure, the blood component needed to diagnose a suspected abnormality or treat a known disease is separated and the remaining blood is returned to the donor. Pheresis can also be described as a blood purification process.

During pheresis, whole blood is collected from one arm of the donor and this goes into a machine called 'cell separator'. The blood is spun in the machine and components separated and after the desired component is collected into a special bag, the red cells and other components are returned to the donor. As most blood is returned to the donor, pheresis facilitates a donor to donate more of a specific component. There are two main types of pheresis. One is removal of platelets - platelet pheresis and removal of plasma - plasmapheresis.

Plateletpheresis: This is especially used in patients who have leukemia or aplastic anemia and are receiving chemotherapy. They need platelets as cancer and cancer treatments can deplete the body of platelets. Platelets are necessary to prevent potentially fatal bleeding problems. Platelet is a very precious component of blood that can be stored only for five days and only about one tablespoon of platelet can be collected from one unit.

Plasmapheresis: Otherwise known as therapeutic plasma exchange, in plasmapheresis, the cells from the straw colored liquid portion of the blood which contains the clotting factors, infection fighting antibodies and other proteins are removed. Plasma is necessary to regulate blood pressure and maintain the mineral balance in the body. Fresh frozen plasma is also administered to control disseminated intravascular coagulation.

A flexible tube is inserted into the donor's arm. Blood is slowly drawn into a sophisticated machine which separates various components of blood. Each pheresis donation is typed and marked for a specific patient. Both plasmapheresis and plateletpheresis can be conducted in a hospital or blood donation center. There are certain preparatory procedures that a donor needs to follow before undergoing pheresis. He/she should get a good night's sleep, eat a balanced diet, drink plenty of caffeine-free liquids. A donor is also advised not to consume aspirin within 72 hours or ibuprofen within 24 hours before undergoing pheresis. After the donation, the pheresis donor may feel tired for a few hours. The donor should not plan on driving home after the procedure. Heavy lifting or strenuous exercise need be avoided until the following day.

Uremia

Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.

Uremic patients show varied signs and symptoms collectively called as uremic syndrome.

Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.

Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.

Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.

Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.

Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.

To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.

Diseases that affect kidney function:

• Bright disease - Glomerulonephritis
  
  
• Chronic hypertension
  
  
• Diabetes mellitus
  
  
• Kidney diseases (Kidney failure, Kidney anomalies)
  
  
• Bladder cancer
  

Body conditions:

• Urinary stones that block flow of urine
  
  
• Enlarged prostate glands (in males)
  
  
• Injury to kidney
  
  
• Renal artery occlusion or embolism
  
  
• Cardio vascular problems (excessive bleeding, congestive heart failure)
  
  
• Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
  
  
• Burns
  
  
• Lupus
  

How is Uremia diagnosed?

Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.

• A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
  
  
• In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
  
  
• A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
  
  
• Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
  
  
• Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.

How is Uremia treated?

If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.

• Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
  
  
• Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
  
  
• Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
  
  
• is done to filter the waste out of the blood while the kidneys recover.
  
  
• Kidney transplant is another choice.
  
  
• Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.

Fibrinogen level

Fibrinogen is a blood plasma protein that is made by the liver. It is required by the body in adequate levels to stop bleeding during an injury. Too high or too little fibrinogen doesn't favor the body. Too little fibrinogen can impair the body's ability to form a stable blood clot thus resulting in bleeding disorders. High levels predispose a person to coronary and cerebral artery disease, even if other risk factors are low.

For over 10 years, extensive study on Fibrinogen levels and its impact on health are being conducted. The observations are:

• High fibrinogen levels are on par with other known risk factors such as elevated LDL cholesterol, elevated triglycerides, obesity and diabetes.
  
  
• There is ample data that indicates a genetic connection. Fibrinogen levels have been found to be high in persons with a family history of heart disease.
  
  
• Exposure to cold increases fibrinogen levels by 23%. Consequently, mortality from heart attack and stroke are higher in winter compared to hot summer months.
  
  
• High levels of fibrinogen suggest atherosclerosis. It may also worsen existing injury to artery walls.
  
  
• Above normal fibrinogen levels increases the risks of heart attacks (two times more as compared to those with low level) and strokes.

To assess Fibrinogen levels, a blood test is required. Normal fibrinogen level is considered to be between 200 and 400 mg/L. Based on fibrinogen test results, preventive measures can be taken to keep the heart healthy. Hence Fibrinogen test is part of a general evaluation of cardiovascular disease. A test to measure fibrinogen levels is recommended for: