Therapeutic apheresis (plasma exchange or cytapheresis): Indications and technology
- Joy L Fridey, MD
Joy L Fridey, MD
- Regional Medical Director
- American Red Cross Blood Services, Southern California
- Andre A Kaplan, MD
Andre A Kaplan, MD
- Professor of Medicine
- University of Connecticut Health Center
Therapeutic apheresis is an extracorporeal treatment that removes blood components from patients; it is used for the treatment of conditions in which a pathogenic substance or component in the blood is causing morbidity.
This topic review will present an overview of the types of indications for which therapeutic apheresis is effective and practical issues in the apheresis technology. Complications of therapeutic apheresis are discussed separately. (See "Therapeutic apheresis (plasma exchange or cytapheresis): Complications".)
Many of the specific indications for therapeutic plasma exchange (TPE) are presented in separate topic reviews on the specific clinical conditions for which TPE is indicated.
The following terminology is used to describe procedures related to therapeutic apheresis:
●Apheresis – An umbrella term for "taking away" a blood component. Apheresis includes plasmapheresis (taking away plasma) and cytapheresis (taking away blood cells). We do not use the term "pheresis," which is a shortened pronunciation (slang) for apheresis.
- COHEN S, FREEMAN T. Metabolic heterogeneity of human gamma-globulin. Biochem J 1960; 76:475.
- Lockwood CM, Worlledge S, Nicholas A, et al. Reversal of impaired splenic function in patients with nephritis or vasculitis (or both) by plasma exchange. N Engl J Med 1979; 300:524.
- Schroeder JO, Euler HH, Löffler H. Synchronization of plasmapheresis and pulse cyclophosphamide in severe systemic lupus erythematosus. Ann Intern Med 1987; 107:344.
- Leitman SF. American Association of Blood Banks/American Society for Apheresis survey, 1992 (unpublished data).
- Rock G, Canadian Apheresis Study Group survey, 1991, personal communication.
- Clark WF, Rock GA, Buskard N, et al. Therapeutic plasma exchange: an update from the Canadian Apheresis Group. Ann Intern Med 1999; 131:453.
- Rock G, Clark B, Sutton D, et al. The Canadian apheresis registry. Transfus Apher Sci 2003; 29:167.
- Leitman SF, Ciaverella D, McLeod B, et al. Guidelines for Therapeutic Hemapheresis, American Association of Blood Banks, Bethesda 1994.
- Schwartz J, Winters JL, Padmanabhan A, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013; 28:145.
- Szczepiorkowski ZM, Winters JL, Bandarenko N, et al. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25:83.
- Smith JW, Weinstein R, Hillyer KL, et al. Therapeutic apheresis: a summary of current indication categories endorsed by the AABB and the American Society for Apheresis. Transfusion 2003; 43:820.
- Schwartz J, Padmanabhan A, Aqui N, et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2016; 31:149.
- Shaz BH, Linenberger ML, Bandarenko N, et al. Category IV indications for therapeutic apheresis: ASFA fourth special issue. J Clin Apher 2007; 22:176.
- Kaplan AA. Therapeutic plasma exchange: core curriculum 2008. Am J Kidney Dis 2008; 52:1180.
- Davenport RD. Therapeutic apheresis. In: (AABB) Technical Manual, 17th ed, Roback JD (Ed), AABB Press, Bethesda 2011.
- Kaplan AA, Halley SE. Plasma exchange with a rotating filter. Kidney Int 1990; 38:160.
- Kaplan AA. Towards a rational prescription of plasma exchange: The kinetics of immunoglobulin removal. Semin Dial 1992; 5:227.
- Kaplan AA. A simple and accurate method for prescribing plasma exchange. ASAIO Trans 1990; 36:M597.
- Tabor E. The epidemiology of virus transmission by plasma derivatives: clinical studies verifying the lack of transmission of hepatitis B and C viruses and HIV type 1. Transfusion 1999; 39:1160.
- Technical Manual, 11th ed, Walker RH (Ed), American Association of Blood Banks, Bethesda 1993. p.37.
- Therapeutic Apheresis, Kolins J, Jones JM (Eds), American Association of Blood Banks, Arlington 1983. p.2.
- Keller AJ, Urbaniak SJ. Intensive plasma exchange on the cell separator: effects on serum immunoglobulins and complement components. Br J Haematol 1978; 38:531.