New apheresis indications in hematological disorders

Area of Science:

• Hematology
• Medical Technology
• Evidence-Based Medicine

Background:

• Therapeutic apheresis is a vital treatment for numerous diseases.
• The American Society for Apheresis (ASFA) Guidelines are updated triennially to reflect the latest evidence and clinical expertise.
• The 2016 ASFA Guidelines expanded to include 87 diseases and 179 indications.

Purpose of the Study:

• To review three newly identified therapeutic apheresis indications for hematological disorders.
• To discuss the evidence and recommendations for these new indications.

Main Methods:

• Review of the 2016 American Society for Apheresis (ASFA) Guidelines.
• Identification and analysis of new apheresis indications for hematological conditions.

Main Results:

• Three new indications for therapeutic apheresis in hematological disorders are presented: therapeutic plasma exchange for hemophagocytic syndrome and for hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, and red blood cell exchange for preventing rhesus (D) alloimmunization.
• All three indications are classified as ASFA Category III with a Grade 2C recommendation, signifying an uncertain role and limited evidence.

Conclusions:

• The newly introduced ASFA Category III indications with Grade 2C recommendations underscore the need for further research.
• Basic, translational, and clinical studies are essential to strengthen the evidence base for these apheresis applications in hematological disorders and improve clinical practice.