Leukapheresis - Risks and Advantages

What Is Leukapheresis?

Leukapheresis is a procedure done by healthcare professionals to extract white blood cells from the blood. This is done to ease symptoms that occur when a person has abnormal white blood cells in the blood that are multiplying uncontrollably. During this procedure, the blood is taken from the patient's bloodstream and is processed to isolate the white blood cells from the red blood cells, plasma, and platelets from the blood. After the procedure, the blood is returned to the circulation.

This procedure is usually done to reduce the excessively high number of white blood cells (WBC) in the body that may occur due to conditions like leukemia. Moreover, this can also be performed to collect blood and bone marrow stem cells to help rebuild bone marrow after undergoing chemotherapy for certain blood cancers. However, this condition does not cure blood disorders or blood cancers, but it can be combined with immunotherapy to manage conditions like leukemia, prostate cancer, and other types of cancer.

What Are the Indications of Leukapheresis?

Leukapheresis may be used in the following situations

• Patients who have a very high white blood cell count.

• When the patient’s blood cells are needed for a transplant back into the patient at a later date.

• Cells for research purposes.

What Is the Purpose of Leukapheresis?

White blood cells are a crucial part of the body’s immune system. They consist of different types of cells, such as neutrophils, lymphocytes, eosinophils, basophils, and monocytes. These cells help in fighting infections or diseases in the body. Some of these white blood cells act directly on the target or disease-causing cells, while other cells are responsible for activating or coordinating the immune response. Therefore, leukapheresis can be used to extract all types of white blood cells or a specific type of white blood cell based on the treatment, which is explained below -

1. Chronic Lymphocytic Leukemia (CLL):

The high white blood cell count is called leukocytosis, and leukapheresis may be used to decrease this excessively high white blood cell count. This is commonly caused by certain types of leukemia (blood cancer), such as chronic lymphocytic leukemia (CLL). In rare cases, this can even lead to a medical emergency called leukostasis, in which the white blood cells form a cluster and block the blood flow. This may lead to symptoms like shortness of breath, rapid heartbeat, hypoxia (low blood oxygen), and coma. Therefore leukapheresis helps in lowering the risk of leukostasis and other complications like heart failure or breathing problems.

2. CAR T-Cell Therapy:

Chimeric antigen receptor (CAR T-cell) therapy is the latest form of immunotherapy in which white blood cells are harvested and altered in the laboratory to stimulate a specific immune response.

The harvested cells are named T-cells, which are tasked to recognize disease-causing agents and initiate an immune response in the body. Therefore this therapy helps fight certain types of cancers. These harvested T-cells are altered in the lab to create a receptor that matches the specific type of cancer, and these cells, when introduced into the body, recognize the cancer cells and help in killing the cancer-causing cells by secreting proteins.

3. Granulocytopenia:

Leukapheresis can be used in patients with a disease called granulocytopenia. In this, there are low levels of white blood cells called granulocyte present, which include neutrophils, eosinophils, and basophils. Granulocytopenia can occur due to certain genetic disorders, systemic infections, drugs, or autoimmune conditions. Therefore in this condition, granulocytes are harvested from a donor and are introduced into the patient’s body. However, this is considered controversial as the recipient body sometimes does not accept the donor’s cell and therefore is only used as a last resort.

What Are the Possible Risks of Leukapheresis?

As with all other medical procedures, leukapheresis also has some risks associated with it. However, this procedure generally is considered safe and is done when there is a medical emergency. Therefore patients should discuss all the possible side effects or risks associated with this procedure before going for it. Some of the common risk factors include -

• Hypocalcemia - This means a sudden drop in blood calcium level leading to symptoms like muscle spasms, irregular heartbeat, numbness, and tingling sensation in the hands and feet.

• Anemia - This means the low count of red blood cells that transport oxygen throughout the body. Symptoms related to this include fatigue, pale skin, irregular heartbeat, dizziness, and shortness of breath.

• Thrombocytopenia - This means a low level of platelets which helps in the mechanism of blood clotting. The symptoms related to this condition include easy bruising and bleeding, nosebleeds, and blood in the urine or stool.

• Systemic or Local Infections - Infections are commonly seen in immunocompromised patients, such as patients with advanced HIV infection. Therefore antibiotics or other antimicrobials may be prescribed to treat infections.

What Are the Advantages of Leukapheresis?

• Leukapheresis can be a life-saving procedure that is done when patients have abnormally high levels of white blood cells.

• This helps in quickly removing the excess number of white blood cells so other treatments can be performed on the patient.

• This also helps in the collection of bone marrow stem cells that can be used to promote bone marrow recovery after a cancer treatment or chemotherapy.

How to Prepare for Leukapheresis?

Before going for leukapheresis, several tests may be advised by the healthcare provider, which may include the -

• Additional blood tests such as complete blood count may be advised by healthcare providers to check the level of other blood cells like red blood cells or platelets.

• Electrolyte tests.

• To check kidney and liver function.

• Blood coagulation tests are done to check for normal blood clotting.

How Is Leukapheresis Done?

To perform this procedure, a specialized apheresis machine is used that removes the blood from the arm, and the blood is then processed in the machine to remove the intended cells and is then injected into the patient’s body at the right temperature.

• Firstly the patient is seated next to the apheresis machine,and one or more IV (intravenous) lines will be placed in the patient's arm.

• If the apheresis machine is continuous, then the IV line is placed in both arms to facilitate the continuous flow of blood in and out of the body. If the machine is non-continuous, then the processed blood is returned to the body in phases.

• In case a catheter is used, the line has to be flushed with the saline solution, and a special attachment is required to connect it to the machine.

• To prevent any blood clotting and clogging of the IV line. An anticoagulant (blood thinner) like Heparin is injected into the IV or catheter line.

• The blood that is collected from the body is spun at high speeds of around 900 to 1,300 rotations per minute to separate different types of white blood cells from the remaining blood.

• Once it is done, the separated white blood cells are transferred to the sterilized chamber, and the remaining blood is injected back into the patient’s body.

Conclusion

Leukapheresis is one of the most common and important procedures done in cases of blood cancer that helps in relieving the symptoms and improving the quality of life. This can be used in immunotherapy to target specific cancer cells and helps in treating the condition. This is a easy and safe procedure, and the prognosis is also very good. However, patients should always discuss the procedure to have a better understanding and feel less stressed on the day of the procedure.