Apheresis

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. It’s also known as pheresis or hemapheresis.

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.

There are two 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. Different apheresis types include:

• 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.

What diseases does it treat?

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.

Blood cancers

Healthcare providers may use apheresis to treat:

• 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:

• Sickle cell anemia.
• Cryoglobulinemia.
• Thrombotic thrombocytopenic purpura.

Neurologic disorders

Healthcare providers may use plasma exchange to treat:

• Guillain-Barré syndrom.
• Multiple sclerosis.
• Myasthenia-gravis.

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

How should I prepare for this procedure?

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.

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.

What happens during apheresis?

In general, this procedure follows the same steps:

1. You’ll sit in a comfortable chair or on a bed.
2. Your provider will insert a needle into a vein in each of your arms. Each needle connects to a catheter, which is a thin, flexible tube. In some cases, your provider may use a central venous catheter.
3. One catheter carries blood from your body to the machine that will separate blood elements.
4. Once that’s done, the catheter in your other arm returns the remaining blood elements to your body.

What happens after this procedure?

Most people can go about their daily routine after completing apheresis. Because healthcare providers use apheresis in many ways, it’s best to ask your healthcare provider or donor center team what to expect.

What are the benefits of apheresis?

Apheresis enables healthcare providers to obtain the right blood element for a given condition. It’s also how people with certain blood disorders can receive healthy blood cells to replace unhealthy ones.

What are the risks or complications of apheresis?

Like most medical procedures, apheresis may have complications or risks. If you’re participating in apheresis, your healthcare provider will explain any potential complications or risks. And providers will be on hand during the procedure. Don’t hesitate to let them know if you don’t feel comfortable or think apheresis is causing issues. Potential risks or complications may include:

• Allergic reactions: Some people may be allergic to plasma or red blood cells that providers use to replace blood cells during apheresis.
• Bleeding: Sometimes, the process of inserting a needle into a blood vessel to obtain blood causes excessive bleeding.
• Blood clots: People with underlying conditions like cancer, diabetes or cardiovascular disease are at risk for blood clots.
• Electrolyte imbalance: Electrolytes are minerals in your body that support important body functions. Your electrolyte levels may go up or down during apheresis.
• Fluid overload: Rarely, too much fluid returns to your body during apheresis, causing swelling.
• Hypocalcemia: This happens when your blood calcium levels drop during apheresis because the machine uses anticoagulants to remove blood.
• Infection: Rarely, infection happens from needle insertion.
• Low blood pressure (hypotension): Apheresis decreases the amount of blood in your body (blood volume). When you have less blood circulating through your body, your blood pressure may drop. Your blood pressure may drop because of anticoagulants that providers use to keep blood from clotting during apheresis. It may also drop due to vasodilation.
• Nerve damage: Occasionally, inserting a needle or catheter damages nerves and causes numbness, tingling or weakness.

When should I call my healthcare provider?

Your provider will explain what kind of symptoms you may have after apheresis. Contact your provider if you have symptoms that are more severe or intense than you expect.