JPAC Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee

11: Therapeutic apheresis

Essentials

  • Therapeutic plasma exchange (TPE) using an automated cell separator removes harmful large molecules, such as antibodies, from the circulation.
  • Human albumin (± saline) is the usual replacement fluid.
  • Solvent detergent treated fresh frozen plasma should be used for TPE in thrombotic thrombocytopenic purpura.
  • TPE is only indicated for conditions where there is good evidence it is effective and the benefits outweigh the risks.
  • Therapeutic erythrocytapheresis (replacement of abnormal red cells) is mainly used to treat or prevent complications of sickle cell disease.
  • Less commonly used therapeutic apheresis procedures include leucapheresis and plateletpheresis to reduce dangerously high white cell or platelet counts, extracorporeal photopheresis to inactivate T-lymphocytes and column immunoadsorption to remove specific antibodies.