Therapeutic Apheresis

Therapeutic Apheresis is a term used to describe treatments that involve the removal of blood cells for either treatment or storage.

Blood Stem Cell Collection

Hematopoietic Progenitor Cells (HPC), or Peripheral Blood Stem Cells (PBSC), are immature cells that grow and divide to become mature red blood cells, white blood cells, or platelets. HPCs are collected before your anticipated transplant and given back to you after you have had high-dose chemotherapy or collected and given to your sibling or related recipient.

Prior to collection, you will be given a medication called G-CSF (Growth Colony Stimulating Factor), which will cause your bone marrow to increase its production of stem cells and stimulate the stem cells to move from the bone marrow into your bloodstream.

To collect the stem cells, you will need either two separate IVs – one in each arm – or a central venous catheter that has two lumens (ports). Your IVs or catheter ports will be attached to the apheresis machine so that one brings blood to the machine and the other returns the blood to your body. The apheresis machine collects only the stem cells and returns the other blood components to you.

The procedure takes about 3-4 hours and is usually repeated for 2-5 days until a sufficient number of the stem cells have been collected. The procedure does not hurt.

After the collected stem cells are returned to you or your recipient, they travel through the blood to the interior of the bones, divide, and differentiate to become whatever type of blood cells the body needs (red blood cell, white blood cell, or platelet).

To prepare for the collection procedure, maintain good nutrition and avoid fatty foods for 24 hours prior. On the days you are scheduled for collection, wear comfortable clothes that will allow easy access to your central venous catheter. A family member or friend may accompany you and stay with you throughout the procedure. It is a good idea to bring a book or some other quiet activity to do during the procedure.

Possible Side Effects

  • Dizziness
  • Numbness in fingers and lips
  • Shortness of breath
  • Decrease in blood pressure
  • Bleeding
  • Muscle cramping
  • Infection
  • Blood loss (minimal)
  • Hematoma (accumulation of blood at IV needle site)

You will be observed closely for any side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

Therapeutic Leukapheresis (White Blood Cell Reduction)

Therapeutic white blood cell (WBC) reduction is done to remove the excess volume of immature white blood cells circulating in the peripheral blood. White blood cells are made in the bone marrow and are important for fighting infections. In certain conditions, such as newly diagnosed leukemia, too many immature white blood cells are produced, and they “crowd out” the normal cells of the blood. Therefore, it is often necessary to remove these excess immature cells.

To collect the excess WBCs, you will need either two separate IVs – one in each arm – or a central venous catheter that has two lumens (ports). Your IVs or catheter ports will be attached to the apheresis machine so that one brings blood to the machine and the other returns the blood to your body. The apheresis machine collects only the WBCs and returns the other blood components to you.

The procedure takes about 2-4 hours and is repeated as often as your clinical condition requires.

Possible Side Effects

  • Dizziness
  • Numbness in fingers or lips
  • Decrease in blood pressure
  • Bleeding
  • Infection
  • Enlarged lymph nodes

You will be observed closely for any side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

Therapeutic Plasma Exchange

The therapeutic plasma exchange procedure is used to remove plasma that may contain abnormal properties.

To collect the abnormal plasma, you will need either two separate IVs – one in each arm – or a central venous catheter that has two lumens (ports). Your IVs or catheter ports will be attached to the apheresis machine so that one brings blood to the machine and the other returns the blood to your body. The apheresis machine collects only the abnormal plasma and replaces it with fresh frozen plasma, cryoprecipitate, or albumin.

This procedure usually takes between 2-5 hours and may be repeated daily as your condition requires.

You may have a reaction to the new plasma.

  • Chills
  • Fever
  • Rash

If you do have a reaction, your doctor will order a medication to relieve the symptoms. You will be monitored closely until the symptoms disappear.

Possible Side Effects

  • Dizziness
  • Numbness in fingers and lips
  • Chills
  • Shortness of breath
  • Bleeding
  • Infection
  • Decrease in blood pressure

You will be observed closely for all side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

Prosorba Immunoadsorption (Antiplatelet Antibody Reduction)

Also known as Extracorporeal immuno-adsorption (ECI) or protein immuno- adsorption therapy.

Platelets are blood cells that prevent bleeding by helping the blood to clot.

Patients often have low platelet counts from chemotherapy. To prevent bleeding in these people, platelet transfusions are given. After many platelet transfusions, however, and in the course of certain autoimmune disorders, the body sometimes produces antibodies that destroy the platelets and make it difficult for the body to maintain an adequate number of platelets to prevent abnormal bleeding. ECI is a procedure that removes plasma from the blood and filters it through a Prosorba column to remove the antiplatelet antibodies. The treated plasma is then re-infused into the body.

The procedure takes about 2-3 hours and is repeated every other day for a total of six treatments.

Possible Side Effects

  • Dizziness
  • Slight blood loss
  • Infection
  • Decrease in blood pressure

You will be observed closely for all side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

Plateletpheresis (Platelet Reduction)

Plateletpheresis is used to reduce an increased number of platelets caused by thrombocytosis, a condition that increases a person’s risk of bleeding and excessive blood clotting. Plateletpheresis relieves the symptoms of bleeding or excessive blood clotting by rapidly reducing the number of platelets.

To collect the excess platelets, you will need either two separate IVs – one in each arm – or a central venous catheter that has two lumens (ports). Your IVs or catheter ports will be attached to the apheresis machine so that one brings blood to the machine and the other returns the blood to your body. The apheresis machine collects only the excess platelets and returns the other components of your blood to you.

The procedure takes about 3 hours and is usually done several times to reduce the platelets to a safe number. Your doctor will monitor your blood work and order this procedure based on your platelet count. A family member or friend may stay with you throughout the procedure. It is a good idea to bring a book or some other quiet activity to do during the procedure.

Possible Side Effects

  • Dizziness
  • Numbness in fingers and lips
  • Shortness of breath
  • Bleeding
  • Infection
  • Decrease in blood pressure

You will be observed closely for all side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

Photopheresis (UV Treatment of Leukocytes)

Photopheresis is a treatment for various disorders such as mycosis fungoides, scleroderma and graft-versus-host-disease (GVHD). The process takes 3-4 hours to complete, is performed through one intravenous access port, and has 3 basic stages:

(1) leukapheresis    (2) photoactivation    (3) reinfusion

This procedure involves removing your leukocytes (white blood cells) from your blood and exposing them to ultraviolet A light (UVA). About 1-1/2 hours before the procedure, you will be given a light-activated drug (8-methoxpsoralen) by mouth. White blood cells will be collected using the apheresis machine and then passed through a photoactivation circuit that exposes the cells to UVA light. The UVA light activates the drug and your cells are treated. The treated cells are returned to you (re-infused) through your central venous catheter or through an intravenous line in your arm.

The procedure is usually done on two consecutive days, every 3-6 weeks or as indicated by your condition.

Possible Side Effects

  • Nausea
  • Anxiety
  • Insomnia
  • Depression
  • Sunlight sensitivity

You will be observed closely for all side effects during the procedure. If any of these symptoms persists after the procedure, you should notify your doctor.

After the procedure, you will be VERY sensitive to sunlight, so you MUST take proper precautions.

  • Avoid exposure to the sun for 24 hours after each treatment.
  • When outside, use sunglasses and wear clothing that covers as much of your body as possible.
  • Sunscreen SPF 15 should be used on all areas of exposed skin not protected by clothing.