Therapeutic apheresis

Therapeutic applications using semiautomated blood cell separators have improved the clinical management of several disorders through cellular or plasma depletion, or by rapid erythrocyte or plasma replacement. Cytapheresis procedures may remove large numbers of platelets or leukocytes in proliferative disorders, or induce and maintain a lymphopenia in "autoimmune" diseases. Rapid reductions in circulating paraproteins, autoantibodies, and immune complexes can be achieved to augment longer-term cytotoxic or immunosuppressive therapy. Therapeutic apheresis is adjunctive or palliative, not curative, and is usually short-term rather than chronic. Familiarity with the evolving indications for intervention with apheresis is essential for maximal benefit and minimal risk to the patients recommended for therapy.