Apheresis - Types, Side Effects, and Procedure

What Is Apheresis?

An apheresis is a medical approach in which the whole blood from a donor is removed followed by separating one particular component from it. This is followed by reintroducing the blood back into the bloodstream of the donor or patient. The blood components that are removed include platelets or plasma, or leukocytes that are contributing to a disease state. Apheresis technology can be used also to provide blood components for donation therapy. Apheresis therapy must be done in association with medications and treatments, like steroids or chemotherapy.

What Diseases Can Be Treated by Apheresis?

Conditions treated with apheresis include

• Breast or colon cancer.

• Graft versus host disease - It is a condition that occurs after certain bone marrow or stem cell transplant resulting in immune cells attacking multiple organs and inducing a cytokine storm or an inflated inflammatory reaction.

• Hodgkin’s disease - It is a type of cancer affecting lymphatic drainage.

• Leukemia, which involves the production of too many white blood cells that can cause blood to thicken and interfere with organ function. Apheresis is used for stem cell transplants where the stem cells are harvested and put in patients with leukemia and lymphoma.

• It is used to improve multiple myeloma.

• Sickle cell disease is a genetic condition where the red blood cells are shaped abnormally and are unable to carry oxygen effectively.

• Myasthenia gravis is an autoimmune neuromuscular disease that causes weakness and rapid fatigue.

• Thrombotic thrombocytopenic purpura is an uncommon blood disorder causing platelet clumping due to a lack of a needed blood enzyme.

• It is used as part of clinical trials that include a collection of and treatment with car T cells (used to treat cancer), dendritic cells, and regenerative medicine.

How Is Apheresis Performed?

Sometimes, only one component may be required to be removed or replaced to treat certain illnesses. Apheresis uses a centrifuge to separate blood components by density. Traditional blood donation involves a process where whole blood (one unit) is taken from a donor. This is sent to a laboratory where the blood is separated into its four components and stored or given to patients after surgery, an accident, illness, or following chemotherapy.

In apheresis, the blood is temporarily removed from the vein and put through an apheresis machine. The whole blood is introduced into a chamber that is spinning and separates blood components, like plasma, platelet-rich plasma, white blood cells (WBCs), and red blood cells (RBCs) by gravity along the walls of the chamber. The whole process occurs while the donor is connected to the separation device. The process takes two to four hours and is similar to a regular blood donation. However, it depends on the patient's illness and the component that needs to be collected.

• Plateletpheresis - It involves supplying human leukocyte antigens HLA-matched platelets to patients who are HLA-sensitized and require platelets.

• Plasmapheresis - It involves removing components, such as clotting factors from the donor. This mechanism can be used more often than whole blood donation. It is used in treating myasthenia gravis (weakening of skeletal muscle) to remove abnormal antibodies in the plasma that interfere with communication between nerves and muscles. Plasmapheresis is an effective treatment for thrombotic thrombocytopenic purpura.

• Leukapheresis - The leukocytes or specific granulocytes can be separated and harvested from a donor to be used in patients, such as neonates to fight infection.

The red blood cells are denser so they settle down followed next by white cells, platelets, and plasma. The needed component is taken into a sterile collection bag, while the remaining blood is returned to the donor with help of a needle that is inserted into a vein of the arm. A central line may also be used in some patients in which a catheter is inserted into a vein in the upper shoulder.

What to Expect When Undergoing Apheresis?

• Apheresis usually takes two to four hours. The patient can comfortably sit in a chair while undergoing the process.

• It involves needles in two arms, unlike one in regular blood donation. The entire process is painless.

• The patient is closely monitored for any adverse reactions that are addressed quickly.

• Patients can eat and drink before the procedure. This allows the blood and plasma to flow more easily. Avoid caffeinated and alcoholic beverages before the therapy.

• The treatment may be repeated once a week, a month, or several times over a week.

What Are the Different Types of Apheresis?

When used to treat diseases, apheresis is referred to as therapeutic apheresis. There are numerous types including

• Autologous Stem Cell Collection - The process involves collecting patients' stem cells before high-dose chemotherapy. The removed blood components are later returned to the patient after chemotherapy. This collection process is used in the treatment of symptomatic myeloma (abnormal plasma cells in the bone marrow), amyloidosis (build-up of abnormal proteins in the tissues and organs), non-Hodgkin’s lymphoma (cancer of the lymphatic system), and sarcoma.

• Volunteer Donor Collection - In this process, the blood components, like stem cells, granulocytes (helps to fight infection), and lymphocytes are collected from the healthy volunteer donors.

• Red Cell Exchange - The red blood cells of the patient are removed and replaced with donor cells. This can be used in treating sickle cell disease.

• Plasma Exchange - During this process, the plasma of the recipient is replaced by the plasma from a donor. It is used in the treatment of hyper viscosity syndrome (a condition where blood thickens and does not flow easily), Guillain-Barre syndrome (the immune system attacks the peripheral nerves), and microangiopathic anemia (destruction of RBC’ within microvasculature).

• Photopheresis - A photosensitizing drug agent and ultraviolet light are used to remove patients' blood. The process is used in treating graft versus host disease, Sezary syndrome (an aggressive type of blood cancer), or solid organ transplant rejection.

What Are the Side Effects of Apheresis?

Some people may have side effects from apheresis that may include

• Allergic reactions.

• Fatigue.

• Nausea.

• Dizziness.

• Discomfort in the arm.

• Lightheadedness.

• Sweating.

• Low blood pressure.

Conclusion:

Apheresis therapy is beneficial for neoplastic, hematologic, and neurological disorders The therapy is generally well tolerated by healthy donors. It involves the automated collection of components in controlled volumes and the efficient use of multiple components from the donor. However, apheresis must be avoided in patients with active infection, unstable heart and lung function, low white blood cells or platelets, or bleeding tendency.