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Apheresis – Procedure, Types and Applications

Apheresis is a medical procedure in which blood is withdrawn from the body, selectively filtered or separated, and then returned to the patient. It is used to treat various diseases.

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Things worth knowing about "Apheresis"

Apheresis is a medical procedure in which blood is withdrawn from the body, selectively filtered or separated, and then returned to the patient. It is used to treat various diseases.

What is Apheresis?

Apheresis (also spelled aphaeresis) is a medical procedure in which blood is drawn from a patient, processed outside the body by a specialized machine to separate and remove specific components, and then returned to the patient's bloodstream. The term originates from the Greek word meaning “to take away” or “removal.” The primary goal of apheresis is to selectively eliminate harmful or unwanted blood components, or to collect specific blood components for therapeutic or research purposes.

Types of Apheresis

Depending on the clinical goal and the blood components targeted, several types of apheresis are distinguished:

Plasmapheresis (Plasma Exchange): The liquid portion of blood (plasma) is separated from blood cells and either discarded and replaced with donor plasma or albumin solution. This is used when harmful antibodies or proteins are circulating in the plasma.
Leukapheresis: White blood cells (leukocytes) are selectively removed from the blood. This method is used in certain forms of leukemia or to collect immune cells for advanced therapies such as CAR-T cell therapy.
Plateletpheresis (Thrombocytapheresis): Platelets (thrombocytes) are separated from the blood, either to treat abnormally high platelet counts or to collect platelets for donation.
Erythrocytapheresis (Red Cell Exchange): Red blood cells are removed and replaced with donor red blood cells, commonly used in sickle cell disease management.
LDL Apheresis: Low-density lipoprotein (LDL) cholesterol particles are specifically filtered from the blood. This is used for patients with severe familial hypercholesterolemia who do not respond adequately to lipid-lowering medications.
Immunoadsorption: A specialized form of apheresis that selectively removes antibodies from blood plasma, often used in autoimmune diseases or before organ transplantation to reduce rejection risk.

Medical Applications

Apheresis is used across a wide range of medical conditions, including:

Autoimmune disorders such as myasthenia gravis, Guillain-Barré syndrome, and multiple sclerosis
Severe lipid disorders (familial hypercholesterolemia)
Blood cancers (leukemia) and other hematological conditions
Sickle cell disease and red blood cell disorders
Preparation for organ transplantation (antibody removal)
Thrombotic thrombocytopenic purpura (TTP)
Severe poisoning or overdose of certain substances

How the Procedure Works

During apheresis, blood is drawn from the patient through a venous access point, typically at the inner elbow or via a central venous catheter. The blood passes through a specialized machine that uses centrifugation, filtration, or adsorption to separate it into its individual components. Unwanted components are removed or replaced, while the processed blood is continuously returned to the patient. A single treatment session typically lasts between one and several hours. Depending on the underlying condition, multiple sessions may be required.

Side Effects and Risks

Apheresis is generally well tolerated, but as with any medical procedure, it may be associated with side effects:

Drop in blood pressure and dizziness
Tingling or numbness (caused by citrate, which is used as an anticoagulant during the procedure)
Infections at the insertion site
Allergic reactions to replacement fluids such as albumin or donor plasma
Increased bleeding tendency due to changes in clotting factors
Fatigue following treatment

Serious complications are rare and are minimized when the procedure is performed in specialized centers under close medical supervision.

Importance in Modern Medicine

Apheresis has established itself as a valuable therapeutic tool in modern medicine. It plays a particularly important role in the fields of immunology, hematology, cardiology, and transplant medicine. Advances in technology have made the procedure more precise and safer, and it can now often be performed on an outpatient basis, significantly improving the quality of life for affected patients.

References

Schwartz, J. et al. - Guidelines on the Use of Therapeutic Apheresis in Clinical Practice. Journal of Clinical Apheresis, 2023.
Deutsche Gesellschaft für Transfusionsmedizin und Immunhämatologie (DGTI) - Guidelines on Apheresis, 2022.
World Health Organization (WHO) - Blood Safety and Availability: Apheresis Procedures. WHO Technical Report, 2021.

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