Apheresis

Aka: Apheresis, Blood Component Removal, Therapeutic Apheresis, Plasmapheresis, Plasma Exchange, Platepharesis, PLEX, Exchange Transfusion, Leukapheresis

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II. Definitions

  1. Apheresis
    1. General term describing the modification of one or several blood components (e.g. Platelets, WBCs) from a donor patient
    2. Blood is separated into individual components, and one or more specific components are removed or modified
    3. Remainder of the blood is then returned to donor patient after component modification
    4. Apheresis is typically performed via central venous access
  2. Plasmapheresis
    1. Type of Apheresis in which plasma is separated from other blood components and modified
    2. Plasmapharesis may be used to remove autoantibodies, immune complexes or toxins
    3. Plasmapheresis indications include Guillain Barre Syndrome and Myasthenia Gravis
  3. Leukapheresis
    1. Type of Apheresis in which White Blood Cells (WBCs) are removed from a donor patient's blood
    2. Remainder of the blood is returned to the donor patient
    3. Leukapheresis indications (examples)
      1. Hyperleukocytosis (Acute Leukemia, esp. Acute Myeloid Leukemia or AML)
      2. Leukostasis
  4. Plasma Exchange (Platepharesis, PLEX)
    1. Type of Plasmapheresis in which patient donor plasma is replaced with other fluids (e.g. FFP, PPF, albumin, Dextran, saline)
    2. Plasma Exchange may be used remove specific antibodies, immune complexes or toxins
    3. Plasma Exchange indications (examples)
      1. Thrombotic Thrombocytopenic Purpura (TTP, remove Von Willebrand Factor large multimers)
      2. Hyperviscosity Syndrome (remove excess Proteins)
  5. Exchange Transfusion
    1. Type of Apheresis in which a patient's Red Blood Cells (RBCs) are replaced with a donor's RBCs
    2. Exchange Transfusion indications (examples)
      1. See Exchange Transfusion for Severe Neonatal Hyperbilirubinemia
      2. Sickle Cell Anemia complications (e.g. Acute Chest Syndrome, CVA in Sickle Cell Disease)
      3. Cerebral Malaria
      4. Autoimmune Hemolytic Anemia
      5. Severe Carbon Monoxide Poisoning

III. References

  1. Bierowski and Nyalakonda (2025) Crit Dec Emerg Med 39(6): 4-21

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