Therapeutic apheresis: where we've been and where we are going

In conclusion, the development of the cell separator which can isovolumetrically remove specific components from the blood has opened a new avenue of research and therapy for patients with a variety of disorders. The techniques are relatively safe and rapid, but still exceedingly expensive. The indications and efficacy of cytapheresis appear relatively clear. The role of lymphocytapheresis in various disease states is still under investigation. Plasma exchange currently must be considered a palliative procedure, but clear and prolonged benefit has resulted in a few instances. The expense will not make this a practical approach in many instances. A combination of immunosuppressive therapy with plasma exchange will evolve as a more appropriate treatment in many instances. Finally, the removal of specific substances from the plasma by immunoadsorption columns should have the advantage of less side effects, less depletion of normal elements of the plasma, and more specifically targeted therapy.