Apheresis is a medical procedure that separates blood into its individual components, allowing healthcare providers to collect specific parts for donation or remove harmful elements to treat various diseases. This sophisticated approach helps manage conditions ranging from blood cancers to autoimmune disorders, offering targeted treatment options that standard therapies cannot always provide.

How Apheresis Helps Manage Disease

The goal of apheresis treatment is not necessarily to cure disease but to control symptoms, slow progression, reduce complications, and improve the quality of life for patients facing serious medical conditions. Unlike medications that work throughout the entire body, apheresis targets specific blood components that contribute to illness. This precision makes it valuable for conditions where abnormal cells or harmful proteins accumulate faster than the body can naturally eliminate them.

Treatment decisions depend heavily on the stage of the disease and individual patient characteristics. A person with early-stage disease may need fewer sessions than someone with advanced complications. Factors like the patient’s overall health, the severity of symptoms, and how quickly the disease is progressing all influence the treatment plan. Healthcare providers carefully evaluate each situation to determine whether apheresis is appropriate and how frequently sessions should occur.

There are standard apheresis treatments that medical societies and clinical guidelines have approved for specific conditions. These established protocols guide doctors in using apheresis safely and effectively. At the same time, researchers continue exploring new applications through clinical trials, testing whether apheresis might benefit additional conditions or whether combining it with other treatments produces better outcomes.

Standard Treatment Methods Using Apheresis

The most established apheresis procedures have been used for decades and are backed by extensive research and clinical experience. These treatments follow specific protocols that have proven safe and effective for particular medical conditions.

Plasmapheresis, also known as plasma exchange, is one of the most common therapeutic apheresis methods. During this procedure, a machine separates plasma—the liquid portion of blood—from blood cells. The patient’s plasma is removed because it contains disease-causing substances like abnormal antibodies or immune complexes that attack healthy tissues. Healthcare providers replace the removed plasma with a solution, most commonly 5% human albumin (a protein prepared from healthy donor blood), or sometimes with fresh frozen plasma from donors. This replacement is necessary because the body needs a certain volume of fluid to function properly.^[1]

A typical plasma exchange removes about 65% of the targeted substances in a single session. Because the body continues producing these harmful substances, patients usually need multiple treatments. The frequency varies considerably: some conditions require daily treatments initially, while others need weekly or biweekly sessions. Treatment duration can range from a few weeks to months, depending on how quickly the disease responds and whether the patient is also taking medications to suppress the underlying problem.^[13]

Plasmapheresis treats several serious neurological conditions through established clinical guidelines. For Guillain-Barré syndrome, a disorder where the immune system attacks nerves and causes weakness and paralysis, plasma exchange helps remove the damaging antibodies and can speed recovery. Patients with myasthenia gravis, a condition causing severe muscle weakness, benefit from removing antibodies that block communication between nerves and muscles. In multiple sclerosis and neuromyelitis optica, plasma exchange may help during severe flare-ups that don’t respond to standard treatments.^[1]

For blood disorders, apheresis takes different forms depending on what needs to be removed. Leukapheresis removes excess white blood cells in patients with leukemia who have dangerously high counts. When white blood cells multiply uncontrollably, they can cause serious complications like bleeding in the brain, difficulty breathing, and other problems. The procedure helps reduce these cells quickly while chemotherapy works to control the underlying cancer.^[1]

Platelet depletion addresses the opposite problem—too many platelets. Platelets help blood clot, but excessive numbers can cause complications including both abnormal clotting and paradoxical bleeding. The apheresis machine selectively removes platelets while returning other blood components to the patient. This provides rapid relief from dangerous symptoms.^[1]

Red blood cell exchange transfusion is particularly important for patients with sickle cell disease. In this inherited condition, abnormal hemoglobin causes red blood cells to become rigid and crescent-shaped. These damaged cells block blood vessels, causing severe pain, organ damage, and potentially life-threatening complications. During red cell exchange, the apheresis machine removes the patient’s sickle cells and simultaneously replaces them with healthy donated red blood cells. This procedure can prevent complications, treat acute crises, and improve quality of life for people living with this chronic condition.^[1]

Photopheresis represents a specialized form of apheresis with immunomodulatory effects. The machine collects white blood cells called lymphocytes from the patient’s blood. These cells are then treated with a medication called methoxsalen (also known as 8-methoxypsoralen) that makes them sensitive to ultraviolet light. The treated lymphocytes are exposed to UVA light inside the machine before being returned to the patient’s bloodstream. This process changes how the immune system behaves, though the exact mechanism isn’t fully understood. Photopheresis has shown benefit for cutaneous T-cell lymphoma, a cancer affecting the skin, and for graft-versus-host disease, a complication that can occur after stem cell or bone marrow transplantation. It may also help treat organ transplant rejection.^[1]

The duration of apheresis procedures varies by type. Platelet donation or depletion typically takes between one and a half to two hours. Plasma exchange usually requires about two hours but can extend to three or four hours depending on how much plasma needs to be removed and the patient’s size. Photopheresis sessions generally last between one and a half to four hours. Red blood cell exchange can take three to four hours. These timeframes include the setup, the actual procedure, and a brief recovery period.^[2]

Preparation for apheresis depends on the specific type of procedure. Patients are generally advised to drink plenty of fluids for several days before their appointment to ensure good blood flow. Eating a healthy meal beforehand is recommended, though fatty foods should be avoided as they can interfere with the procedure. For platelet donation or platelet-related procedures, patients must avoid aspirin for at least two days beforehand, as aspirin affects platelet function. Other non-steroidal anti-inflammatory drugs should be avoided for 24 hours before the procedure.^[19]

Most apheresis procedures are performed with needles inserted into veins in the arms. Healthcare providers look for suitable veins that can handle the blood flow required by the machine. If a patient’s veins are too small, fragile, or difficult to access, a temporary central line (a catheter inserted into a large vein in the chest or groin) may be necessary. This allows blood to be withdrawn and returned more easily. Some patients have permanent ports or catheters if they need frequent treatments.^[9]

Side effects from apheresis are generally manageable but can occur. Common issues include fatigue, nausea, dizziness, and feeling cold during the procedure. The chilling happens because the anticoagulant solution used to prevent clotting is at room temperature, cooler than body temperature. Healthcare providers address this by offering blankets and heating pads. Some patients experience tingling around the mouth or in their fingers and toes. This occurs because the anticoagulant citrate temporarily lowers calcium levels in the blood. The sensation usually resolves quickly, but providers can pause the procedure and sometimes give calcium supplements like Tums if needed.^[12]

Blood pressure may drop during the procedure, causing lightheadedness. This happens because fluid is temporarily outside the body in the machine. Patients are monitored closely, and the machine can be adjusted to minimize this effect. Allergic reactions to replacement fluids are possible but uncommon. Serious complications like abnormal heart rhythms, seizures, or excessive bleeding are very rare but require immediate medical attention if they occur.^[12]

Treatment Approaches in Clinical Trials

While established apheresis protocols effectively treat many conditions, researchers continue investigating new applications and improvements to existing methods. Clinical trials explore whether apheresis might benefit additional diseases, whether modified techniques work better, and how apheresis combines with newer medications.

One area of active investigation involves using apheresis to collect stem cells for transplantation. This isn’t therapeutic apheresis in the traditional sense—the procedure isn’t treating disease by removing harmful components. Instead, it collects healthy stem cells that can be preserved and later transplanted back into the patient after they undergo intensive chemotherapy for blood cancers like leukemia, lymphoma, or multiple myeloma. Before the collection, patients receive medications for several days that mobilize stem cells from the bone marrow into the bloodstream, where the apheresis machine can collect them. This approach, called peripheral blood stem cell collection, has largely replaced bone marrow harvesting because it’s less invasive and often yields more stem cells.^[1]

Trials are exploring optimal protocols for stem cell collection, including which medications work best to mobilize cells, how many cells need to be collected, and how to process and store them for the best transplant outcomes. Phase II and Phase III studies compare different mobilization strategies and collection techniques to identify approaches that maximize cell yield while minimizing side effects for donors and recipients.

Research institutions are investigating expanded uses for photopheresis beyond its approved indications. Clinical trials examine whether this immune-modulating treatment might help patients with solid organ transplants (heart, lung, kidney) who are experiencing rejection despite standard anti-rejection medications. Early-phase studies have shown promising results, with some patients experiencing improved graft function and reduced need for immunosuppressive drugs. The mechanism appears to involve changing how T-cells (a type of white blood cell) respond to the transplanted organ.^[11]

Researchers are also testing photopheresis for treating graft-versus-host disease that occurs after stem cell transplantation. Phase II trials have demonstrated that photopheresis can reduce symptoms like skin rashes, gastrointestinal problems, and liver dysfunction in patients whose disease doesn’t respond adequately to corticosteroids and other standard treatments. The therapy appears to work by inducing immune tolerance without broadly suppressing the entire immune system, potentially reducing infection risk compared to conventional immunosuppressive drugs.

Another investigational area involves LDL apheresis, also called lipid apheresis. This specialized procedure selectively removes low-density lipoprotein (LDL) cholesterol, very low-density lipoproteins, lipoprotein(a), and triglycerides from plasma using special columns or filters that bind to these fats. Standard cholesterol-lowering medications don’t work for everyone, particularly patients with familial hypercholesterolemia, an inherited genetic condition causing extremely high cholesterol levels from birth. These patients develop severe cardiovascular disease at young ages despite maximum medical therapy.^[9]

Clinical trials are evaluating LDL apheresis combined with newer cholesterol medications like PCSK9 inhibitors to determine if this combination provides better cardiovascular protection than either treatment alone. Studies are also investigating whether LDL apheresis can help patients with recurrent focal segmental glomerulosclerosis (FSGS), a kidney disease that sometimes returns after kidney transplantation. Early results suggest that removing certain lipoproteins may reduce the recurrence rate, though larger trials are needed to confirm this benefit.^[9]

Researchers are exploring ways to make apheresis more selective and efficient. One approach being tested involves immunoadsorption, where plasma passes over columns coated with specific antibodies or antigens designed to bind only the disease-causing substance. This technique theoretically removes harmful components while leaving more beneficial proteins intact, potentially reducing side effects and allowing more frequent treatments. Phase I and early Phase II trials are testing immunoadsorption columns designed to remove specific autoantibodies in conditions like autoimmune encephalitis, pemphigus, and certain kidney diseases.

Clinical studies are examining optimal treatment schedules and durations. For many conditions, the standard protocols were developed decades ago and haven’t been systematically re-evaluated. Trials are comparing different frequencies—daily versus every-other-day versus weekly treatments—to identify schedules that provide the best balance between effectiveness and convenience. Some studies investigate whether maintenance apheresis (regular treatments after initial intensive therapy) prevents disease relapse better than treating only when symptoms return.

Researchers are also studying apheresis as part of combination strategies. For example, trials in patients with antibody-mediated rejection of kidney transplants are testing whether removing antibodies through plasma exchange, combined with giving intravenous immunoglobulin (IVIG) to modulate the immune system, plus newer anti-rejection medications, works better than standard treatment. Similar combination approaches are being investigated for treating severe autoimmune conditions that haven’t responded adequately to conventional therapies alone.

Safety studies continue to refine procedures to minimize risks. Investigators are testing whether certain replacement fluids reduce side effects compared to standard albumin solutions. Phase II trials examine whether warming the anticoagulant before it enters the patient reduces the chilling sensation and citrate-related symptoms. Other studies look at optimal citrate infusion rates that prevent clotting while minimizing calcium-related side effects.

Clinical trials typically follow a structured progression. Phase I trials focus primarily on safety, testing apheresis procedures or protocols in small groups of patients to identify potential risks and determine safe treatment parameters. Phase II trials evaluate effectiveness, studying whether the treatment produces the intended biological effects and clinical improvements in a larger group of patients with the target condition. Phase III trials compare the new approach against current standard treatment to determine if it offers superior outcomes, fewer side effects, or other advantages that would justify changing clinical practice.

Trial locations vary widely. Major academic medical centers in the United States, Europe, and other regions conduct most apheresis research. Patients interested in participating typically need referrals from their regular doctors. Eligibility criteria vary by study but generally include having the specific condition being investigated, meeting certain health requirements, and being able to travel to the research site for regular treatments and follow-up visits. Some trials provide financial assistance for travel and accommodation costs.

Most common treatment methods

• Plasmapheresis (Plasma Exchange)
  • Removes disease-causing antibodies, immune complexes, and abnormal proteins from plasma
  • Replaced with 5% human albumin solution or fresh frozen plasma
  • Used for neurological disorders including Guillain-Barré syndrome, myasthenia gravis, and multiple sclerosis
  • Treats blood disorders like thrombotic thrombocytopenic purpura and cryoglobulinemia
  • Typical duration is about 2 hours per session
  • Usually requires multiple sessions over weeks to months
• Leukapheresis (White Blood Cell Removal)
  • Removes excess white blood cells in patients with leukemia
  • Prevents complications from uncontrolled white cell multiplication including brain bleeding and breathing difficulties
  • Procedures typically last 3 to 4 hours
  • Provides rapid symptom relief while chemotherapy addresses underlying cancer
• Red Blood Cell Exchange
  • Removes abnormal sickle-shaped red blood cells
  • Simultaneously replaces them with healthy donated red cells
  • Prevents pain crises and organ damage in sickle cell disease patients
  • Sessions last approximately 3 to 4 hours
  • May be performed regularly as maintenance therapy or during acute complications
• Photopheresis
  • Collects lymphocytes (white blood cells) from patient’s blood
  • Treats cells with methoxsalen medication
  • Exposes treated cells to UVA light before returning them to patient
  • Modulates immune system function through unclear mechanisms
  • Used for cutaneous T-cell lymphoma, graft-versus-host disease, and organ transplant rejection
  • Sessions last 1.5 to 4 hours
• Platelet Depletion
  • Removes excess platelets when counts are dangerously high
  • Prevents complications from clotting and bleeding
  • Treats conditions causing platelet overproduction
  • Procedures take 1.5 to 2 hours
• LDL Apheresis (Lipid Removal)
  • Selectively removes LDL cholesterol and other harmful lipids
  • Uses special columns or filters that bind to fat molecules
  • Treats familial hypercholesterolemia not controlled by medications
  • May help prevent recurrent kidney disease after transplant
  • Requires regular sessions, typically every 1-2 weeks
• Peripheral Blood Stem Cell Collection
  • Collects healthy stem cells for later transplantation
  • Used before intensive chemotherapy for blood cancers
  • Requires pre-treatment with medications to mobilize stem cells into bloodstream
  • Less invasive than bone marrow harvesting
  • Collection sessions may take several hours and can require multiple days