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Home > Therapeutic Apheresis > Clinical Applications

Clinical Applications

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The American Society for Apheresis (ASFA) has published its recommendations for the clinical utilization of therapeutic apheresis in the Journal of Clinical Apheresis.

 

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Apheresis Applications Committee of the American Society for Apheresis.  Journal of Clinical Apheresis 25:83-177 (2010)

 

Category 1

Therapeutic apheresis is standard and acceptable.  Included are disorders for which apheresis is accepted as first-line therapy, either as a primary stand-alone treatment or in conjunction with other modes of treatment. 

 

Example: plasma exchange in Thrombotic Thrombocytopenic Purpura (TTP) as first-line stand-alone therapy; plasma exchange in myasthenia gravis as first-line in conjunction with immunosuppression and cholinesterase inhibition.

 

Some diseases of Category 1:

 

  • Thrombotic Thrombocytopenic Purpura (TTP)
  • Myasthenia Gravis (MG)
  • Guillain-Barré Syndrome (GBS)
  • Goodpasture's Syndrome
  • Cryoglobulinemia
  • Hyperviscosity Syndrome
  • Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
  • Paraproteinemic Polyneuropathies
  • Sickle Cell Disease (acute stroke)
  • ANCA-associated Rapidly Progressive Glomerulonephritis (Wegener's Granulomatosis – diffuse alveolar hemorrhage, dialysis independence)

Category 2
Therapeutic apheresis is generally accepted.  Included are disorders for which apheresis is accepted as second-line therapy, either as a stand-alone treatment or in conjunction with other modes of treatment. 

 

Example: plasma exchange as stand-alone secondary treatment for acute disseminated encephalomyelitis after high-dose IV corticosteroid failure; extracorporeal photopheresis added to corticosteroids for unresponsive chronic graft-versus-host disease.

 

Some diseases of Category 2:

 

  • Multiple Sclerosis (Acute CNS Inflammatory Demyelinating Disease unresponsive to steroids)
  • Neuromyelitis Optica (Devic's Syndrome)
  • Acute Disseminated Encephalomyelitis
  • Chronic Focal Encephalitis (Rasmussen's Encephalitis)
  • ABO-incompatible Hematopoietic Progenitor Cell Transplantation
  • ABO-incompatible Solid Organ Transplantation
  • Sickle Cell Disease (acute chest syndrome, prevention of transfusion iron overload)
  • Thrombocytosis
  • Catastrophic Antiphospholipid Syndrome
  • Graft versus Host Disease, skin (acute and chronic) – Photopheresis
  • Systemic Lupus Erythematosus (Severe cerebritis or diffuse alveolar hemorrhage)
  • Cold Agglutinin Disease (life-threatening)

Category 3
Optimum role of apheresis therapy is not established.  Decision making should be individualized.

 

Example: extracorporeal photopheresis for nephrogenic systemic fibrosis; plasma exchange in patients with sepsis and multiorgan failure.

 

Some diseases of Category 3:

 

  • Aplastic Anemia
  • Autoimmune Hemolytic Anemia
  • Paraneoplastic Neurologic Syndromes
  • Erythrocytosis; Polycythemia Vera
  • Hypertriglyceridemic Pancreatitis
  • Acute Liver Failure
  • Immune Complex Rapidly Progressive Glomerulonephritis

Category 4

Included are disorders in which published evidence demonstrates or suggests apheresis to be ineffective or harmful.  IRB approval is desirable if apheresis treatment is undertaken in these circumstances.

 

Example: plasma exchange for Immune Thrombocytopenic Purpura (ITP)

 

Some diseases of Category 4:

 

  • Inclusion Body Myositis
  • Lupus Nephritis
  • Dermatomyositis or Polymyositis
  • Burn Shock Resuscitation