Apheresis

Apheresis is a medical procedure that separates blood into its different components using a specialized machine, allowing healthcare providers to collect specific parts for donation or remove abnormal elements to treat various diseases.

Table of contents

• What is apheresis?
• How apheresis works
• Types of apheresis procedures
• Conditions treated with apheresis
• Preparing for apheresis
• What happens during the procedure
• How long does it take?
• Risks and benefits

pheresis, hemapheresis

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What is apheresis?

Apheresis is a procedure that enables healthcare providers to obtain or remove red blood cells, white blood cells, platelets and plasma for medical treatment^[1]. It’s also known as pheresis or hemapheresis^[1].

There are two main reasons why you may participate in apheresis: You’re donating blood elements, like red blood cells, for someone else to use, or you’re receiving treatment for a medical condition. For example, providers may use apheresis to remove abnormal blood elements^[1].

Human blood is made up of four components: red blood cells, white blood cells, platelets, and plasma. Sometimes, to treat an illness, one of those components may need to be removed or replaced through a process called apheresis^[2].

How apheresis works

In apheresis, a centrifuge machine draws blood from your body and spins the blood to separate its elements. The machine sets aside certain elements and returns the remaining blood cells, platelets and plasma to your body^[1].

A rotating centrifuge or a rotating belt separates the donor’s whole blood into its components based on density. Red cells are the densest, so they go to the bottom. The next in order of density are white cells, platelets, and plasma^[2]. Using sterile equipment, the apheresis operator directs the needed component into a collection bag; the others return to the donor through a needle inserted into a vein in the arm. Some patients have the blood collected and returned through a central line, a catheter inserted into a vein in the upper shoulder^[2].

To stop the blood from coagulating, an anticoagulant is automatically mixed with the blood as it is pumped from the body into the apheresis machine^[5].

Types of apheresis procedures

Different apheresis types include^[1]:

• Leukapheresis: Providers do this treatment to remove white blood cells from your blood. The treatment eases symptoms that happen if your white blood cells are multiplying uncontrollably.
• Peripheral blood stem cell collection: In this case, providers use apheresis to obtain immature stem cells for stem cell transplant.
• Photopheresis: Healthcare providers treat several conditions with photopheresis. This procedure changes your lymphocytes so they can do more to fight intruders like cancerous cells and foreign viruses and bacteria. During photopheresis, a centrifuge machine removes lymphocytes and treats them with UVA light before they’re returned to you.
• Plasmapheresis (plasma exchange): Providers use plasmapheresis to treat several serious medical conditions through a process called plasma exchange.
• Platelet depletion: Platelets help your blood to form clots. High platelet counts may cause complications like clotting or bleeding. If you have excess platelets, providers will do platelet depletion to remove platelets before returning blood to you.
• Red blood cell exchange transfusion: Healthcare providers use apheresis to remove unhealthy red blood cells and replace them with healthy donated red blood cells.

Conditions treated with apheresis

Apheresis plays a big role in how healthcare providers treat a wide range of conditions. For example, people going through intense chemotherapy for cancer may have apheresis to preserve healthy stem cells that they’ll receive after recovering from treatment. Healthcare providers typically use apheresis to treat blood cancers, blood disorders and some neurological disorders^[1].

Blood cancers

Healthcare providers may use apheresis to treat^[1]:

• Acute myeloid leukemia
• Certain types of lymphoma, including cutaneous T-cell lymphoma
• Multiple myeloma
• Waldenstrom macroglobulinemia

Blood disorders

Apheresis is a treatment for many common blood disorders, including^[1]:

• Sickle cell anemia
• Cryoglobulinemia
• Thrombotic thrombocytopenic purpura

Neurologic disorders

Healthcare providers may use plasma exchange to treat^[1]:

• Guillain-Barré syndrome
• Multiple sclerosis
• Myasthenia gravis

In addition, apheresis may be a treatment for graft vs. host disease or organ transplant rejection^[1].

Preparing for apheresis

People participate in apheresis for many different reasons, so there’s no single way to prepare for the procedure. For example, if you’re donating peripheral blood stem cells for a stem cell transplant, you’ll take medication for several days beforehand to move stem cells from your bone marrow to your bloodstream^[1].

In general, it’s a good idea to drink lots of fluid the few days before you participate in apheresis. But your provider will explain what you should specifically do to prepare. They’ll also tell you how long the procedure will take^[1].

No aspirin (even low dose) should be taken for 2 days before donation. No non-steroidal anti-inflammatory drugs should be taken within 24 hours. A good meal before donation with plenty of fluids is suggested^[2].

What happens during the procedure

Apheresis involves removing whole blood from a patient or donor, separating out desired components (e.g. plasma, granulocytes or red cells), and returning the remaining blood to the patient or donor^[15].

During apheresis, a catheter (small tube) may be placed in a vein in your upper chest near your collarbone or in a large groin vein. This may be done before or on the day of your apheresis procedure. During apheresis, the catheter is connected to a machine called a blood cell separator. This machine takes out the abnormal blood cells or antibodies and returns the rest of your blood to you^[15].

Blood is removed from one arm, the desired component is removed or collected, and the rest of the blood is returned to the patient through the other arm or the same needle^[2].

How long does it take?

The duration of the procedure varies from patient to patient. Generally, photopheresis takes 1.5-4 hours to complete^[12]. An average plasma exchange procedure lasts about 2 hours^[12]. A typical leukapheresis procedure takes approximately 3 to 4 hours^[12].

The procedure is done for 1 to 5 hours each day over several days. It can be done in your hospital room or within the clinic^[15].

Donor apheresis takes two to four hours and is similar to a regular blood donation^[2].

Risks and benefits

Apheresis is generally safe and well tolerated, but side effects can occur. Common side effects include fatigue, nausea, dizziness, feeling cold and tingling in the fingers and around the mouth, allergic reaction and lowered blood pressure^[12].

Possible side effects also include decreased blood pressure during the procedure, temporary increase in itching, and low grade fever^[12]. Serious complications such as abnormal heart beat, seizures, electrolyte abnormalities, and unexplained bleeding are very rare^[12].

Insertion of the large IV catheters necessary for apheresis can cause complications (eg, bleeding, infection, pneumothorax). Citrate anticoagulant may decrease serum ionized calcium. Replacement of patient’s plasma with a colloidal solution (eg, 5% albumin or fresh frozen plasma) does not replace IgG and coagulation factors^[13].

Most complications can be managed with close attention to the patient and manipulation of the procedure, but some severe reactions and a few deaths have occurred^[13].

It is important to notify medical staff if symptoms occur during the procedure^[12].