Chapter 37 - Overview and Practical Aspects of Therapeutic Apheresis

Abstract

Therapeutic apheresis is the separation and selective removal of a component (plasma, platelets, red blood cells [RBCs], or white blood cells [WBCs]) of a patient's blood that contains a specific or suspected pathogenic agent—that is, antibodies, immune complexes, abnormal RBCs, malignant WBCs, platelets, and protein-bound drug or toxin. When cells are selectively removed, the procedure is termed “therapeutic cytapheresis” or more specifically “leukocytapheresis,” “thrombocytapheresis,” or “erythrocytapheresis.” When plasma is removed and then replaced by either albumin or fresh frozen plasma (FFP), the procedure is called plasmapheresis or therapeutic plasma exchange (TPE). In most cases, therapeutic apheresis is primarily utilized as an adjunctive or secondary therapy. Only for a few conditions, such as thrombotic thrombocytopenic purpura (TTP), TPE is considered the first-line treatment. Apheresis services should adhere to regulations outlined in the AABB Standards for Blood Banks and Transfusion Services and the Code of Federal Regulations. Apheresis should only be performed in facilities that provide trained personnels, equipments, and medications that are necessary to manage serious reactions or problems. Therapeutic apheresis requires experienced medical knowledge and judgment. Both the primary physician and the apheresis physician should evaluate the patient for treatment. The apheresis physician should make the final determination regarding appropriateness of apheresis and suitability of the patient.