Patient education: Therapeutic apheresis (The Basics)

What is apheresis? — This is a procedure in which the blood is filtered to remove parts that are abnormal and causing symptoms. "Therapeutic" means that it is done to treat a health problem.

Blood is made up of these different parts:

●Red blood cells ("RBCs") carry oxygen to the body.

●White blood cells ("WBCs") help fight infections.

●Platelets help the blood to clot.

●Plasma is the liquid part of the blood. It contains many types of proteins, antibodies, and other substances.

There are a few types of apheresis. Examples include:

●Plasmapheresis – This removes plasma and replaces it with an IV fluid.

●Plasma exchange – This removes plasma and replaces it with donated plasma.

●Cytapheresis – This removes specific kinds of cells:

•RBC exchange, or exchange transfusion – This removes RBCs and replaces them with donated RBCs.

•Leukocytapheresis or leukapheresis – This removes WBCs.

Why might I need apheresis? — Apheresis can be used for certain disorders. Apheresis does not actually treat the cause of the disease. Instead, it helps by removing or reducing abnormal cells or antibodies.

For example, apheresis might be used for:

●Some "autoimmune" diseases – These are conditions where the immune system attacks healthy cells. A common example is "thrombotic thrombocytopenic purpura" ("TTP"), which is treated with plasma exchange.

●Diseases that attack the nervous system – A common example is "Guillain-Barré syndrome" ("GBS"), which is treated with apheresis.

●Multiple myeloma – This is a type of blood cancer in which the blood makes a lot of antibodies that can cause problems in other parts of the body. Apheresis might be used as a part of treatment.

●Some types of leukemia where the WBC count is very high and causing problems – This might be treated with leukapheresis.

●A problem related to sickle cell disease, like acute chest syndrome or stroke – RBC exchange can quickly reduce the amount of abnormal RBCs.

●Preventing rejection or other problems after an organ transplant – Apheresis can help remove antibodies that are attacking the donated organ.

How is apheresis done? — It is usually done in a hospital. It might be done in an infusion center if you are well enough to be out of the hospital.

Before you start apheresis, you will need a way for the blood to leave and return to your body:

●In some cases, the staff will place 2 "IVs." An IV is a thin tube that goes into a vein. The IVs might be in the same arm or 1 in each arm.

●If apheresis will be needed more often, the doctor might place a device like a central line or port.

Plastic tubes connect the IV or central line to an apheresis machine. Blood comes out through 1 tube, passes through the machine, and returns to your body through the other tube.

How do I prepare for apheresis? — The doctor or nurse will tell you if you need to do anything special to prepare. Your doctor will review your "health history" and might have you get lab tests. Reviewing your health history might include asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbs or supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during apheresis? — When it is time for the procedure:

●You will lie in bed or sit in a reclining chair. The staff will place the IVs (if needed). They will connect the IVs or central line to long tubing. Blood will flow through the tubing to the apheresis machine and back to your body.

●The apheresis machine separates the blood and collects or removes parts. The rest is returned to your body.

●When you are finished, the staff will remove the IVs or disconnect the central line. They will cover the areas with clean bandages. You might need to leave the bandages on for a few hours.

●Apheresis usually takes 3 to 4 hours.

What happens after apheresis? — After your procedure, the staff will watch you closely to make sure that you are feeling well. In some cases, you can go home after your treatment. You will continue to have other treatments for your illness.

What are the risks of apheresis? — Your doctor or nurse will talk to you about all of the possible risks and answer your questions. Your risks depend on why you are getting apheresis.

Possible risks include bleeding, bruising, or infection from the IV. Apheresis can cause low blood pressure, and you might feel dizzy, numb, tingly, or cold. Some people also have nausea during apheresis.

People who get a transfusion during apheresis might have an allergic reaction, infection, or other "transfusion reaction."

What else should I know? — Before you go home, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Blood transfusion (The Basics)
Patient education: Myasthenia gravis (The Basics)
Patient education: Guillain-Barré syndrome (The Basics)
Patient education: Multiple myeloma (The Basics)
Patient education: Leukemia in adults (The Basics)
Patient education: Leukemia in children (The Basics)
Patient education: Sickle cell disease (The Basics)
Patient education: Lung transplant (The Basics)
Patient education: Liver transplant (The Basics)
Patient education: Heart transplant (The Basics)
Patient education: Kidney transplant (The Basics)

Patient education: Blood donation and transfusion (Beyond the Basics)
Patient education: Multiple myeloma treatment (Beyond the Basics)
Patient education: Heart transplantation (Beyond the Basics)