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New apheresis indications in hematological disorders
1aDepartment of Pathology, University of Alabama at Birmingham, Birmingham, Alabama bDepartment of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital, New York, New York, USA.
Insights
This review highlights three new therapeutic apheresis indications for hematological disorders, including hemophagocytic syndrome and alloimmunization prevention. These indications require further research to establish their optimal role in clinical practice.
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.
Purpose Of Review:
Therapeutic apheresis can be used to treat many diseases. The American Society for Apheresis (ASFA) publishes Guidelines on the use of therapeutic apheresis every 3 years with the goal of providing the best available evidence for apheresis practice as well as clinical expertise. The 2016 (7th ed.) ASFA Guidelines contain 87 diseases (up from 78 in the 6th ed.) and 179 indications. This review outlines three new therapeutic apheresis indications for hematological disorders.
Recent Findings:
The three new nonmalignant and nontransplant-related hematological disorders discussed are therapeutic plasma exchange procedures for hemophagocytic syndrome, hemolysis, elevated liver enzymes, and low platelets syndrome, and red blood cell exchange to prevent alloimmunization after exposure to rhesus (D)-positive red blood cells. All three indications are ASFA category III indications (i.e., optimal role of apheresis therapy is not established) with Grade 2C recommendation (weak recommendation, low-quality evidence).
Summary:
Although the three new therapeutic apheresis indications related to hematological disorders are ASFA category III with Grade 2C recommendations, along with other ASFA category III with Grade 2C recommendations, they may form the list of diseases for which basic, translational, and clinical research is needed to provide better evidence for clinical practice.
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