Hemapheresis
(Pheresis)

• What is hemapheresis?
• How is hemapheresis performed?
• What are some possible complications of hemapheresis?
• For what diseases is hemapheresis used?
• What are contraindications to hemapheresis?

What is hemapheresis?

Hemapheresis is a treatment for certain serious medical conditions that involves separating blood into its major components and removing the part that contains disease-provoking elements or elements that are toxic to the body as a result of disease.

Hemapheresis is also called pheresis.

How is hemapheresis performed?

All hemapheresis procedures involve connecting the blood in the patient's veins through tubing to a machine that separates the blood components. The separation is done by either a centrifuge process or a filtration process on the blood in the machine. After the separation, the component of the blood that is felt to contain the harmful, disease-provoking elements is discarded, while the remainder of the blood components are reinfused back into the patient. The entire procedure is painless and typically takes about two hours.

The actual hemapheresis procedure can be named according the component of blood that is removed from the patient. Each type of procedure has a different role to play in treating different diseases. Typical components that are removed include plasma (plasmapheresis), all types of white blood cells (leukopheresis), lymphocyte white blood cells (lymphopheresis), red blood cells, (erythropheresis), platelets (plateletcytapheresis), and total plasma exchange (removal of plasma and replacement with fresh frozen plasma.

What are some possible complications of hemapheresis?

Hemapheresis can be complicated by bleeding and a tendency to bleed (because clotting factors are removed), infection and a tendency toward infection (because the immune system is somewhat suppressed when antibodies are removed), low blood pressure (as fluids are removed), muscle cramping (as low blood calcium can occur and other electrolytes can be imbalanced).

For what diseases is hemapheresis used?

A number of diseases definitely respond to hemapheresis, some are probably responsive to treatment, and others may or may not respond to treatment.

Hemapheresis can be very effective in treating myasthenia gravis, Waldenstrom's macroglobulinemia, Goodpasture's syndrome, hyperviscosity syndrome (such as mixed cryoglobulinemia, thrombotic thrombocytopenic purpura, Refsun's disease, clogging of blood vessels (leukostasis) cause by severely elevated white blood count in leukemia, severely elevated platelet counts in leukemia or myeloproliferative disorders.

Hemapheresis can be effective in treating systemic lupus with life-threatening complications, severe vasculitis, polymyositis or dermatomyositis, severe rheumatoid arthritis, rapidly progressive glomerulonephritis, chronic autoimmune polyneuropathy, familial hyperlipoproteinemia.

Hemapheresis has been tried with some success reported in patients with idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, pemphigus, aplastic anemia, and as leukopheresis in hairy cell leukemia.

What are reasons the hemapheresis procedure should not be used?

Hemapheresis is generally avoided if a patient has active infection, unstable heart or lung condition, severely low white blood cell or platelet count, bleeding tendency, or a significantly low blood pressure. The overall status of the patient as well as the seriousness and progression of the disease in question are all taken into consideration relative to these contraindications for each individual patient.

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