Apheresis in the Philippines

This is a retrospective study of 131 patients who underwent 479 therapeutic apheresis (TA) procedures at St. Luke's Medical Center, in the Philippines, from 1994 to 2003. Diseases were classified according to indication categories using the American Society for Apheresis (ASFA) guidelines. Seventy-eight percent of the patients belonged to ASFA Category I, 14% to Category II, 8% to Category III, and none in Category IV. The most common indication was for neurological disorders (62%), mainly acute inflammatory demyelinating polyneuropathy (49%) and myasthenia gravis (40%). The remaining disease groups were hematologic (25%), renal and metabolic (8%), and autoimmune and rheumatic diseases (5%). Oral corticosteroids are the preference of many for the treatment of CIDP, being much less expensive than IVIG infusion or TA. Favorable response is noted in the use of the latter to prevent kidney transplant rejection through antibody removal among pre-sensitized patients before transplantation. Complete recovery was seen in 2 of 4 patients with acute hepatic failure. The negative outcome of controlled studies in the literature has limited our utilization of TA for the treatment of systemic lupus erythematosus. Immunoadsorption for idiopathic thrombocytopenic purpura has not been performed locally due to the unavailability and prohibitive cost of affinity columns. Factors affecting the practice of TA in our country are cited. Organization of a multicenter study group and an apheresis national registry may lead to a better future of TA in the Philippines.