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Types of Apheresis Procedures

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Types of inpatient and outpatient apheresis procedures provided at Inova include Extracorporeal Photopheresis (ECP), Leukapheresis (White Blood Cell Depletion), Plasmapheresis (Therapeutic Plasma Exchange), Plateletpheresis (Platelet Depletion), Red Blood Cell (RBC) Exchange and Therapeutic Phlebotomy. Below you can find detailed descriptions of each including reasons a patient might need a particular treatment, what happens during the procedure, amount of time required for each procedure, risks and benefits.

Patient Instruction Sheets:

Extracorporeal Photopheresis (ECP)

REASON FOR PROCEDURE:

In certain conditions like Graft Versus Host Disease (GVHD), cutaneous T-cell Lymphoma or organ transplant rejection, medications alone are often not effective. The addition of photopheresis for these diseases may improve symptoms. It is not known exactly how photopheresis works; it is thought that the procedure changes the activity of the immune system. This alteration of the immune system can help decrease symptoms or treat transplant rejection.

THE PROCEDURE:

Photopheresis is a medical procedure in which blood is collected into a specialized machine and separated into white blood cells and the other components of blood. The white blood cells are then treated with a medication called methoxsalen, which makes them sensitive to ultraviolet light. The treated white blood cells are exposed to an ultraviolet light inside the machine and returned to patient.

DURATION:

The duration of the procedure varies from patient to patient. Generally, this procedure takes 1.5-4 hours to complete.

RISKS AND BENEFITS:

Photopheresis is generally safe and well tolerated, but side effects can occur. Possible side effects include fatigue, decreased blood pressure during the procedure, dizziness, temporary increase in itching, and low grade fever.

Download ECP Patient Instructions

Leukapheresis (White Blood Cell Depletion)

REASON FOR PROCEDURE:

Leukapheresis is used to remove the extra white blood cells and prevent complications such as bleeding in the brain, shortness of breath and other problems.

THE PROCEDURE:

Blood is removed from one arm the white blood cells are removed, and the rest of the blood is returned to the patient through the other arm.

DURATION:

The length of the procedure depends on how many white blood cells need to be removed. A typical procedure takes approximately 3 to 4 hours.

RISKS AND BENEFITS:

This is a safe procedure but side effects can occur. Common side effects include fatigue, nausea, dizziness, feeling cold, tingling around the mouth, tingling fingers and decreased blood pressure. Serious side effects like seizures or abnormal heart beat are very rare. It is important to tell medical staff if these symptoms occur.

Download Apheresis Procedure Instruction Sheet (general)

Plasmapheresis (Therapeutic Plasma Exchange)

REASON FOR PROCEDURE:

Plasma exchange is used when it is necessary to remove disease-causing proteins, or replace missing proteins in a patient. These abnormal proteins are caused by an aberration in the immune system and can attack healthy organs. It is often not possible to remove only the protein that is causing the disease. Therefore, the plasma must be removed to treat the illness.

THE PROCEDURE:

Plasma exchange is a procedure in which a machine separates and removes the patient’s plasma. Many types of machines are available. The most common ones use a centrifuge to separate the blood into its different parts. The plasma that is removed from the patient must be replaced with another protein solution such as 5% human albumin (most commonly). In some cases, plasma donated from other people is used. A solution containing citrate is used to keep your blood from clotting during the treatment.

DURATION:

This is different from patient to patient, but an average plasma exchange procedure lasts about 2 hours.

RISKS AND BENEFITS:

Plasma exchange is a safe procedure but side effects can occur. Common side effects include fatigue, nausea, dizziness, feeling cold and tingling in the fingers and around the mouth, allergic reaction and lowered blood pressure. It is important to notify medical staff if these symptoms occur. Serious complications such as abnormal heart beat, seizures, electrolyte abnormalities, and unexplained bleeding are extremely rare.

Download Apheresis Procedure Instruction Sheet (general)

Plateletpheresis (Platelet Depletion)

REASON FOR PROCEDURE:

Platelet depletion is used when platelet counts are dangerously elevated and patients show symptoms. High platelet counts may carry a risk of stroke and heart attack.

THE PROCEDURE:

During the procedure, a centrifuge is used to remove the excess platelets. An anticoagulant solution containing sodium citrate is used to prevent blood from clotting in the machine.

DURATION:

A typical procedure lasts an average of 2 hours, but may be longer for some patients.

RISKS AND BENEFITS:

Platelet depletion is a safe procedure but side effects can occur. Common side effects include feeling cold, tingling in the fingers and around the mouth, nausea and dizziness. It is important to notify medical staff if these symptoms occur. Serious complications such as cardiac rhythm disturbances and seizures are extremely rare.

Red Blood Cell (RBC) Exchange

REASON FOR PROCEDURE:

RBC exchange transfusion is used when it becomes necessary to replace (exchange) abnormal red blood cells. If these cells are not exchanged, serious problems may occur, including shortness of breath, chest pain, lung tissue damage, or strokes.

THE PROCEDURE:

RBC exchange transfusion is a procedure in which a machine removes a patient’s abnormal red blood cells using a centrifuge to separate the blood into its various parts. These abnormal red cells are replaced with several red blood cell units from healthy volunteer blood donors.

DURATION:

The length of the procedure varies from patient to patient, and depends on the amount of abnormal red blood cells that need to be exchanged. A normal RBC exchange transfusion lasts approximately 2-3 hours.

RISKS AND BENEFITS:

RBC exchange transfusion is a safe procedure, but side effects can occur. Common side effects include fatigue, nausea, dizziness, feeling cold and tingling in the fingers and around the mouth. It is important to tell medical staff if these symptoms occur. Serious problems such as allergic reactions to red blood cells and infections due to viruses such as hepatitis and HIV are extremely rare.

Therapeutic Phlebotomy

REASON FOR PROCEDURE:

Therapeutic phlebotomy is ordered by doctors at periodic intervals as a treatment for patients with blood dyscrasias, such as Hemochromatosis and non-Hemochromatosis (polycythemia vera, erythrocytosis, and other conditions that abnormally increase red cell mass or erythrocytosis).

THE PROCEDURE:

This procedure involves the removal of blood from a vein to treat a blood disorder. It is usually done to remove whole blood and red blood cells, and/or iron stores. Removal of blood from the body is called phlebotomy. The removed blood will be disposed.

DURATION:

A typical procedure should last an average of 15 to 30 minutes.

RISKS AND BENEFITS:

The patient should be closely monitored for any adverse reactions, such as arm bruising, arm soreness, hematoma, vasovagal reactions, nausea and vomiting.

Download Apheresis Procedure Instruction Sheet (general)