Apheresis
Apheresis, also known as pheresis, is a medical procedure that involves the withdrawal of blood from a patient, separating and removing specific components—such as plasma (plasmapheresis), white blood cells (leukapheresis), or platelets (plateletpheresis)—before returning the remaining blood to the patient. This technique is often utilized in the treatment of patients with elevated white blood cell or platelet counts due to blood cancers or as a side effect of chemotherapy. In addition to therapeutic applications, apheresis is commonly used to collect donor blood components from healthy individuals to aid cancer patients lacking these elements.
The process of apheresis typically involves positioning the patient comfortably, placing an intravenous line to withdraw blood, and using an apheresis machine to separate the desired components. The entire procedure can last from one hour and fifteen minutes to four hours, depending on the specific treatment. Patients may need to manage calcium levels during the procedure, and post-treatment monitoring is essential to check for potential complications, such as bleeding or low calcium levels. As technology advances, new methods and techniques in apheresis are being developed, expanding its applications in modern medicine.
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Subject Terms
Apheresis
ALSO KNOWN AS: Pheresis, automated blood collection
DEFINITION: Apheresis is a process in which the patient’s blood is withdrawn from the body, the plasma (plasmapheresis), white blood cells (leukapheresis), or platelets (plateletpheresis), or other elements are removed from the blood, and then the blood is returned back to the patient. Therapeutic apheresis is used to treat patients who have an elevated white blood count or platelet count related to a cancer disease process. Apheresis is also used to collect donor blood components from healthy people to be given to cancer patients who lack those components due to the disease or the side effects of treatment.
Cancers treated:Blood cancers (hematological), other cancers being treated with chemotherapy
Why performed: Blood cancers can cause the bone marrow to malfunction and produce too many platelets or white blood cells, creating a life-threatening situation if the levels of these cells are not decreased. Oral medications can be given if levels are only slightly elevated, but for more acute cases, apheresis may be used. Specialized apheresis treatments are also performed. Photopheresis is used to treat graft-versus-host disease as well as lymphoma. Apheresis is also used to harvest stem cells for bone marrow transplantation. Therapeutic plasma exchange is used to relieve the side effects of chemotherapy treatment of lung cancer, breast cancer, colon cancer, thymomas, and Hodgkin's disease.
Patient preparation: Patients who have low levels of calcium may need to take a calcium supplement prior to having apheresis done. Patients may also receive calcium tablets during the procedure to help with the side effects associated with low calcium counts.
Steps of the procedure: The patient is positioned for comfort, usually in a recliner or a bed. An intravenous (IV) line is placed in the arm, usually the inner elbow, to allow for the blood to be withdrawn. The blood travels from the IV through a tube and then circulates through the apheresis machine to pull out the cells. The blood is then returned into the other arm through another IV that is placed there. This procedure can take from one hour and fifteen minutes to four hours to perform, depending on the blood component removed, and is done in a variety of settings. Apheresis can be done at the bedside, in a clinic, or even in a mobile apheresis lab.
New indications for apheresis were available in the twenty-first century, and new technology was also developed. Coupled plasma filtration absorption has shown promise in treating septic patients by removing the sources of inflammation through plasma separation and absorbent cartridge purification. High blood-flow methods of apheresis decreased procedure time. New technologies were being developed that used novel materials and manufacturing methods that addressed the challenges of traditional apheresis techniques.
After the procedure: After apheresis, the patient will be monitored for bleeding from the IV site. Pressure may need to be applied for five to ten minutes directly to the insertion site. Patients will also be monitored for tingling of the face and arms, which indicates low calcium levels, as well as dizziness. Cancer patients with an elevated platelet count or white blood cell count have their counts lowered to a safe level and then are placed on an oral agent or receive chemotherapy to maintain the safe levels.
Risks: Bleeding and infection may occur. Rare episodes of an air embolus have occurred with the removal of access lines.
Results: The patient will have the blood count lowered to a safe level to receive chemotherapy for the underlying cancer diagnosis. If a patient is given apheresis because the count is too high and does not follow up with additional medications, then the count will again rise to an unsafe level and the patient will need to receive apheresis therapy again.
Bibliography
“About ASFA.” American Society for Apheresis, www.apheresis.org/page/About‗ASFA. Accessed 14 June 2024.
“Apheresis: How It Works.” Cleveland Clinic, 7 Feb. 2024, my.clevelandclinic.org/health/procedures/apheresis. Accessed 14 June 2024.
Bosch, Thomas. “Recent Advances in Therapeutic Apheresis.” Journal of Artificial Organs: The Official Journal of the Japanese Society for Artificial Organs, vol. 6.1, 2003, pp. 1-8. doi:10.1007/s100470300000. Accessed 14 June 2024.
Connelly-Smith, Laura, et al. "Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue." Journal of Clinical Apheresis, vol. 38, no. 2, 2023, pp. 77-278, hdoi.org/10.1002/jca.22043. Accessed 14 June 2024.
“Donate Blood, Plasma or Platelets.” Red Cross Blood Donation, www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations.html. Accessed 14 June 2024.
Tabuchi, T., et al. “Granulocyte Apheresis as a Possible New Approach in Cancer Therapy: A Pilot Study Involving Two Cases.” Cancer Detection & Prevention, vol. 23.5, 1999, pp. 417–21.