APHERESIS

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.
 DONOR APHERESIS
• In donor apheresis, a healthy person donates blood using the apheresis
machine, which is programmed to collect the desired blood component –
either red blood cells, white blood cells, platelets, or plasma.
• The component can be stored and distributed to hospitals, to be given to a
patient in need.
• Donor apheresis takes longer than a whole blood donation, but is easy and
painless, and has many benefits.
 THERAPEUTIC APHERESIS
• The Transfusion Medicine Service performs therapeutic apheresis on
patients who have an illness associated with an abnormal cellular or
plasma-based blood component. The abnormal parts of the blood are
isolated and removed, then the normal components of the patient’s blood
are returned to the veins.
• If there are too many white blood cells, a leukapheresis can be performed,
or if there are too many platelets, a plateletapheresis can be requested.
 TYPES OF APHERESIS
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 particles. During photopheresis, a centrifuge machine
removes lymphocytes and treats them with UVA light before they’re returned to you.
 CONT..
• 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.
 PROCEDURE
• Depending on the substance that is being removed, different processes are
employed in apheresis. If separation by density is required, centrifugation
is the most common method. Other methods involve absorption onto
beads coated with an absorbent material[2] and filtration.[3]
• The centrifugation method can be divided into two basic categories:
• Continuous flow centrifugation
• Intermittent flow centrifugation
 Continuous flow centrifugation
• Continuous flow centrifugation (CFC) historically required two
venipunctures as "continuous" means the blood is collected, spun, and
returned simultaneously. Newer systems can use a single venipuncture by
pooling blood in a vessel and cycling through drawing and returning blood
though the needle while the centrifuge continuously processes blood
remaining in the vessel.
• The main advantage of this system is the low extracorporeal volume used in
the procedure, which may be advantageous in the elderly and for children.
 Intermittent flow centrifugation
• Intermittent flow centrifugation (IFC) works in cycles, taking blood,
spinning/processing it and then giving back the unused parts to the donor
in a bolus.
• The main advantage is a single venipuncture site.
• It does require a larger extracorporeal volume, and takes significantly
longer to perform the procedure via IFC.
• As such, it is less likely to be used for therapeutic reasons, and is often
seen in Donation Center settings.
 Centrifugation variables
The centrifugation process itself has four variables that can be controlled to selectively
remove desired components.
The first is spin speed and bowl diameter,
The second is "sit time" in centrifuge
The third is solutes added
The fourth is not as easily controllable: plasma volume and cellular content of the donor.
The result in most cases is the classic sedimented blood sample with the RBCs at the
bottom, the buffy coat of platelets and WBCs (lymphocytes, granulocytes, monocytes) in
the middle and the plasma on top
 USES
• Sickle cell anemia: In this genetic condition, red blood cells are shaped
abnormally (like sickles) and can’t carry oxygen through the body
effectively. If they develop a sickle cell crisis, their sickled red blood cells
can be removed using erythrocytopheresis and replaced with healthy cells
from a blood donor.
• Leukemia. Patients with leukemia may have too many white blood cells,
which can cause the blood to thicken and interfere with organ function. In
the leukapheresis process, abnormal white blood cells are removed, and the
rest of the blood is returned to the patient.
 CONT…
• Myasthenia gravis. In this condition, a buildup of abnormal antibodies
(proteins) in the plasma interferes with the communication between nerves and
muscles. Using a type of apheresis called plasmapheresis, plasma is separated
and removed from the patient’s blood and replaced with a protein solution of 5
percent human albumin.
• Thrombotic thrombocytopenic purpura (TTP). This rare blood disorder
causes platelet clumps to form throughout the body due to a lack of a needed
blood enzyme. The most effective treatment is plasmapheresis, followed by
replacement with normal donor plasma, which contains the needed enzyme.
 APHERESIS FOR STEM CELL
TRANSPLANT
• Stem cells, immature cells that develop in the bone marrow, can grow into
red blood cells, white blood cells, or platelets. In patients with some types of
cancers of the blood, such as leukemia and lymphoma, those stem cells can
be harvested from the patient by apheresis.
• The patient is first given a growth factor medication to increase the number
of stem cells, which are then separated through leukapheresis while the rest
of the blood is returned to the patient. The collected stem cells are frozen
and stored until the patient has completed chemotherapy or radiation
treatments.
 ADVANTAGES
Blood element collection: Apheresis can obtain specific blood components,
such as platelets, plasma, or red blood cells, for a patient's condition.
• Blood replacement: Apheresis can replace unhealthy blood cells with
healthy ones from a donor.
• Disease treatment: Apheresis can remove substances from the blood that
cause disease.
• Reduced transfusion risk: Apheresis can reduce the risk of transfusion
reactions and bloodborne infections.
 CONT…
• Reduced donor exposure: Apheresis can reduce the amount of exposure
to other blood donors.
• More frequent donations: Apheresis allows donors to donate more
frequently than whole blood donation.
• Hemodynamic stability: Apheresis can provide greater hemodynamic
stability.
• Lower risk of electrolyte imbalances: Apheresis can reduce the risk of
electrolyte imbalances.
 Technological advances in
apheresis
1. Automated Machines: Improved accuracy and
efficiency with minimal manual intervention.
2. Faster Centrifugation: Reduces procedure time
and enhances component separation.
4. Membrane Filtration: Faster and more comfortable
alternative to centrifugation.
5. Photopheresis: Advanced UV systems for treating
cancers and autoimmundisoderder.
 Future prospect of apheresis
Chronic Disease Management: Effective for conditions
like autoimmune diseases and hyperlipidemia.
Cell-based Therapies: Used for isolating cells in cancer
immunotherapy.
Gene Therapy: Potential for treating genetic disorders.
Technological Advancements: More efficient, accessible, and
cost-effective machines.
 COMPLICATION
• 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.
 CONT…
• 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): 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.
 Challenges and limitation
Cost: Expensive due to specialized equipment and skilled
staff.
Accessibility: Limited availability in resource-poor areas.
Expertise: Requires trained professionals and advanced
machinery.
Side Effects: Risks like infections, allergic reactions, and
volume changes.
Duration: Time-consuming with multiple sessions needed.
Patient Selection: Only suitable for specific conditions.
Awareness: Limited knowledge among healthcare providers
and patients.
 Conclusion
Valuable Procedure: Effective for treating conditions like
autoimmune diseases and blood cancers.
Targeted Treatment: Fewer side effects compared to traditional
therapies.
Challenges: High cost, limited accessibility, and need for
specialized equipment.
Technological Advancements: Improvements will make the
procedure more efficient and accessible.
Future Potential: Expanded applications with ongoing research
in personalized medicine.
Success Factors: Requires careful patient selection and skilled