Transfusion medicine handbook

9. Other Services Provided by NZBS

9.1 Therapeutic Apheresis

Some NZBS centres provide therapeutic apheresis programmes to hospitals using a centrifugal cell separator.

Therapeutic plasma exchange (TPE) is an established first-line treatment in some conditions and second-line treatment in several others. TPE may be combined with other medical therapy in managing diverse conditions such as hyperviscosity syndromes, Guillain-Barré syndrome, thrombotic thrombocytopenic purpura, chronic inflammatory demyelinating polyneuropathy, familial hypercholesterolaemia and renal transplant rejection. It is also sometimes used for the treatment of myasthenia gravis, polymyositis, SLE and other autoimmune disorders. The potential hazards of plasma exchange should be taken into account when considering this treatment.

Leukapheresis may be used to reduce leucostasis in patients with very high white cell counts. Similarly, plateletpheresis may occasionally be used for patients with complications due to thrombocytosis.

Replacement fluids used for TPE usually include albumin or fresh frozen plasma (FFP). Saline, usually in combination with albumin, can also be used in certain conditions such as hyperleucocytosis and thrombocytosis. FFP is occasionally used to correct a deficiency of coagulation factors.

Complications of therapeutic apheresis include allergic reactions to FFP, volume overload or hypovolaemia, air embolism, haemolysis, extracorporeal clotting, citrate toxicity, coagulopathy and vasovagal attacks. However, present procedures aim to minimise these complications.

To request therapeutic apheresis, contact a NZBS Transfusion Medicine Specialist/ Medical Officer.