Red Blood Cell Depletion in Patients With Hyperferritinemia: Comparison of Two Apheresis Systems

Red blood cell (RBC) apheresis is, alongside phlebotomy, a standard treatment for iron overload in hereditary hemochromatosis (HH). We compared the serum ferritin (SF) reduction, process parameters, duration, and side effects of two apheresis systems: Spectra Optia apheresis system (Optia) and Alyx apheresis collection system (Alyx). Forty-three patients were RBC depleted with one of the two separators, Optia or Alyx. In total, 186 procedures were performed. The main diagnoses were HH (n = 20) and dysmetabolic iron overload syndrome (DIOS) (n = 21). Around two thirds of the procedures were done with Optia (n = 143) and one third with Alyx (n = 43). A mean volume of 405 and 442 mL of RBCs was withdrawn per single treatment with the Optia and Alyx, respectively. The procedure took 12 min (Optia) versus 26 min (Alyx) with a hematocrit (Hct) reduction of 5% versus 7.5% (p < 0.001). The SF reduction 3 weeks after RBC depletion was not significantly different between the two systems. The amount of anticoagulant used with the Optia was almost half of what was used with the Alyx (63 mL compared to 123 mL). There were no significant adverse events. The advantages of the Alyx include the lower cost and the easy portability. The Optia, on the other hand, has a shorter procedure time, a smaller extracorporeal volume, a lower anticoagulant consumption, a lower rate of complications, and allows a precise Hct adjustment.