What is apheresis?
Apheresis is a medical procedure that involves removing whole blood from a donor or patient and separating the blood into individual components so that one particular component can be removed. The remaining blood components then are re-introduced back into the bloodstream of the patient or donor.
Apheresis is used for the collection of donor blood components (such a platelets or plasma) as well as for the treatment for certain medical conditions in which a part of the blood that contains disease-provoking elements is removed.
Apheresis is also called pheresis or hemapheresis. The terminology used may also reflect the component of blood that is being removed, such as:
- Plasma (plasmapheresis)
- Platelets (plateletpheresis)
- Leukocytes (leukapheresis or leukopheresis)
- Lymphocytes (lymphopheresis or lymphapheresis)
- Red blood cells (erythropheresis)
Total plasma exchange (removal of plasma and replacement with fresh frozen plasma) can also be performed using the apheresis procedure. It is also used for the collection of stem cells from the peripheral blood.
How is apheresis performed?
All apheresis procedures involve directing the blood in the patient/donor'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 desired component of the blood is removed, while the remainder of the blood components are reinfused back into the patient. The entire procedure is painless and typically takes about two hours, or only slightly longer than a conventional blood donation.
What are some possible complications of apheresis?
Serious complications of donor apheresis are rare. Minor complications of donor apheresis can include bleeding at the donation site and feelings of lightheadedness that usually resolve quickly.
More serious complications can occur when apheresis is used to treat serious conditions and include:
- 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).
What diseases can be treated with apheresis?
When used in a therapeutic manner, the apheresis procedure is individualized regarding the frequency of treatments, the volume of blood or components to be removed, and the type of solution used for volume replacement.
The following list of conditions for which apheresis may be of benefit is not all-inclusive. Apheresis can be used in the treatment of:
- myasthenia gravis,
- Waldenstrom's macroglobulinemia,
- Goodpasture's syndrome,
- familial hypercholesterolemia,
- hyperviscosity syndrome (such as mixed cryoglobulinemia, thrombotic thrombocytopenic purpura),
- the HELLP syndrome of pregnancy,
- clogging of blood vessels (leukostasis) cause by severely elevated white blood count in leukemia, and
- severely elevated platelet counts in leukemia or myeloproliferative disorders.
Apheresis can also be effective in certain cases of:
- systemic lupus with life-threatening complications,
- severe vasculitis,
- polymyositis or dermatomyositis,
- severe rheumatoid arthritis,
- rapidly progressive glomerulonephritis,
- chronic autoimmune polyneuropathy, and
- in cases of solid organ transplantation with a high risk of antibody-mediated rejection of the transplant.
SLIDESHOW
Health Screening Tests Every Woman Needs See SlideshowWhat are contraindications to apheresis?
Hemapheresis is generally avoided if a patient has active infection, unstable heart or lung conditions, severely low white blood cell or platelet counts, a 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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Complete Blood Count (CBC)
A complete blood count (CBC) is a calculation of the cellular makeup of blood. A CBC measures the concentration of white blood cells, red blood cells, platelets in the blood, and aids in diagnosing conditions and disease such as malignancy, anemia, or blood clotting problems.
Essential Mixed Cryoglobulinemia
Essential mixed cryoglobulinemia is a condition caused by abnormal blood proteins called cryoglobulins. Symptoms include- joint pain,
- swelling,
- skin vasculitis,
- enlarged spleen, and
- nerve and kidney disease.
What Is a Heart Transplant?
Heart transplant consists of three operations: 1) harvesting the heart from the donor, 2) removing the recipient's damaged heart, and 3) the implantation of the donor heart. The selection and distribution of donor hearts is a careful process so that the hearts are distributed fairly. For the patient requiring a heart transplant, all other important organs in the body must be in good shape. The most common complication of heart transplant is organ rejection.
Leukemia
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice, it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Multiple Myeloma
Multiple myeloma is a form of cancer that develops in plasma cells, the white blood cells that make antibodies. Symptoms include bone pain, weakness, extreme thirst, nausea, frequent urination, and broken bones. Treatment of multiple myeloma depends upon the staging and symptoms of the disease.
Polyarteritis Nodosa
Polyarteritis nodosa is a rare autoimmune disease characterized by spontaneous inflammation of the arteries of the body. The most common areas of involvement include the muscles, joints, intestines, nerves, kidneys, and skin. Polyarteritis nodosa is most common in middle age persons.
Polymyositis and Dermatomyositis
Polymyositis is a disease of the muscle featuring inflammation of the muscle fibers. It results in weakness of the muscles which can be severe and when associated with skin rash, is referred to as dermatomyositis. Although the cause of this disease is unknown, diagnosis includes physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and conformation by a muscle biopsy. Treatment of polymyositis and dermatomyositis includes high doses of cortisone-related medications, immune suppression, and physical therapy.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body.
Lupus (Systemic Lupus Erythematosus or SLE)
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. When only the skin is involved, the condition is called discoid lupus. When internal organs are involved, the condition is called systemic lupus erythematosus (SLE).
Vasculitis
Vasculitis (arteritis, angiitis) is a general term for a group of uncommon diseases which feature inflammation of the blood vessels. Each form of vasculitis has its own characteristic pattern of symptoms. The diagnosis of vasculitis is definitively established after a biopsy of involved tissue demonstrates the pattern of blood vessel inflammation. Treatment is directed toward decreasing the inflammation of the arteries and improving the function of affected organs.