TPE is a medical procedure which involves the removal, treatment, and return of blood plasma or components of blood to the patient. The process generally involves the following steps:

1. Blood Withdrawal: Blood is drawn from the patient, typically through a vein.

2. Separation: The blood is then separated into its components using a centrifuge. Plasma, along with the substances to be removed, is isolated.

3. First Filtration: The plasma is passed through a first filter, which removes the targeted substances.

4. Return of Components: The filtered plasma is returned to the patient, while the blood cells and other components are returned simultaneously or after further processing.

5. Repeat if Necessary: The process may be repeated as needed to achieve the desired therapeutic effect.

Plasmapheresis is often used in the treatment of various medical conditions, including autoimmune disorders, certain neurological diseases, and conditions where specific substances need to be removed from the plasma.

Apheresis Support in Renal (Kidney) Diseases

Double filtration plasmapheresis (DFPP) is a specific technique that uses two filters to remove unwanted substances from the plasma more efficiently. The use of two filters enhances the efficiency of removing targeted substances.

Second Filtration: The plasma that has been separated from the patient's whole blood is then passed through a second filter, providing an additional level of filtration.

It's important to note that medical procedures and techniques can vary, and the specific details of procedures may differ based on the patient requirements, available equipment and disposables, and protocols used by healthcare providers. If you have specific questions about this procedure, it's recommended to consult with a healthcare professional for accurate and up-to-date information.

Double filtration plasmapheresis (DFPP)

Cascade Filteration

Double filtration plasmapheresis (DFPP) is a specific technique that is used using pumps of dialysis equipment. The First filter of the two filters separates, the plasma along with unwanted substances from the plasma more efficiently. The membrane filtration requires high blood flow, usually more than 100 ml/ min, and anticoagulation is achieved using heparin. The Second of the two filters enhances the efficiency of removing targeted substances.

Cascade Filtration is a 'Hybrid' system consisting of plasma separation based on centrifugation followed by filtration using an actual filter. The 'series' setup provides an opportunity to work on lower blood flow even up to 30 ml/min and avoid systemic heparin-based anticoagulation, using citrate regional anticoagulation

Tandem plasma exchange is a medical procedure used in certain therapeutic interventions where Therapeutic Plasma Exchange (TPE) and Continous Renal Replacement Therapy (CRRT) for dialysis are carried out at the same time. The setup is especially suitable for hemodynamically unstable patients due to lower blood flow requirements and avoids systemic heparin-based anticoagulation, using citrate regional anticoagulation. No specific clinical difference in circuits of Series or Parallel has been observed.

Tandem Plasma exchange in the 'Series' circuit is similar to Cascade's 'Hybrid' system consisting of plasma separation based on centrifugation followed by filtration using a 'Dialysis filter' on CRRT. Thus, in the case of Series, efflux plasma of cTPE is influx for Dialysis. 

Another option is 'Parallel', where input from the patient is for both TPE and Dialysis at the same time. The final treated blood is also infused through the same port. Thus, TPE and Dialysis work independently in a 'Parallel' type of circuit. 

Although there is limited experience, however, the results are quite encouraging to use in hemodynamically unstable patients achieving the purpose of both the procedures at same time. Although studies show a decline in Fibrinogen levels by 50%, the sieving coefficient is retained at 100% in both types of circuits.  

Tandem Plasma Eschange

Therapeutic Plasma Exchange (TPE)