Therapeutic apheresis in critically ill patients

Area of Science:

• Critical Care Medicine
• Nephrology
• Hematology

Background:

• Therapeutic apheresis encompasses procedures like therapeutic plasma exchange, erythrocytapheresis, and leukocytapheresis.
• These interventions are utilized in critically ill patients, presenting unique challenges and potential adverse effects.
• The decision to use apheresis requires careful risk-benefit analysis, particularly when alternative therapies have been unsuccessful.

Purpose of the Study:

• To review clinically significant issues encountered in critically ill patients undergoing therapeutic apheresis.
• To highlight the complexities and considerations for the apheresis healthcare team in managing these patients.
• To discuss the balance between beneficial and adverse effects of apheresis in the intensive care unit (ICU) setting.

Main Methods:

• Review of clinically significant issues in critically ill patients requiring therapeutic apheresis.
• Discussion of the benefits and risks associated with various apheresis procedures.
• Analysis of situations where apheresis is considered after failure of alternative therapies.

Main Results:

• Therapeutic plasma exchange can remove harmful toxins and antibodies but also beneficial components like medications and clotting factors.
• Citrate anticoagulant used in apheresis can chelate essential cations.
• Apheresis procedures in critically ill patients require meticulous management due to potential complications.

Conclusions:

• Therapeutic apheresis is a complex intervention in critically ill patients, necessitating a thorough understanding of its multifaceted effects.
• Careful patient selection and monitoring are paramount to optimize outcomes and mitigate risks.
• The review underscores the importance of weighing the potential benefits against the inherent risks in the context of intensive care.