Therapies

Apheresis

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Apheresis (blood washing) is a procedure that removes blood components or disease-causing substances from the blood. Read all about the apheresis, how it works and what the risks are.

ArtikelübersichtApherese

  • What is an apheresis?
  • When do you perform an apheresis?
  • What do you do with an apheresis?
  • What are the risks of apheresis?
  • What do I have to consider after an apheresis?

What is an apheresis?

Apheresis is a procedure that removes blood components or disease-causing substances from blood or blood plasma. This happens outside the body (extracorporeal) - with the help of an apheresis machine. The purified blood or blood plasma then flows back into the body. Aphereses are distinguished in:

  • Erythrocytapheresis: gain of red blood cells (erythrocytes)
  • Leukapheresis: gain of white blood cells (leukocytes)
  • Stem cell apheresis: gaining stem cells
  • Thrombocytapheresis: gain of platelets (platelets)
  • Plasmapheresis: Separation of blood plasma from whole blood
  • Lipidapheresis or LDL apheresis: separation of cholesterol and blood lipids
  • Apheresis of disease-causing substances

Blood and blood components

About 45 percent of whole blood is made up of solid components, and about 55 percent is made up of blood plasma, which serves as a transport medium for glucose (sugar), lipids (fats), proteins (protein), hormones, coagulation factors and dissolved gases. The solid components of the blood are separated from the plasma by centrifuging - they are composed of:

  • Erythrocytes: Red blood cells that transport the oxygen to the cells.
  • Leukocytes: white blood cells that are responsible for the immune system.
  • Platelets: Platelets that curdle the blood when injured.
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When do you perform an apheresis?

Basically, two apheresis methods can be distinguished:

Preparative apheresis

In preparative apheresis, blood components are recovered for later use as a therapeutic. These include, in particular, platelets, stem cells, erythrocytes and leukocytes. Stem cell apheresis now replaces the bone marrow removal in cancer patients, in which the blood-forming system is damaged in the context of a chemo- or steel therapy. The stem cells thus obtained are returned to the patient after the therapy and begin the rebuilding of the blood. Autologous donations are, in contrast to allogeneic donation, donor and recipient and the same person.

Therapeutic apheresis

Therapeutic apheresis is a purification process for removing substances from the blood. In lipid apheresis, for example, the doctor cleanses the blood in cases of severe lipid metabolism disorders such as LDL (low-density lipoproteins) - a transporter for cholesterol or other fats. Lipid apheresis is always used when blood lipid levels can not be lowered by diet or medication. In renal function disorders, dialysis is used as a so-called renal replacement procedure and purifies the blood of toxic substances. Leukapheresis reduces an excess of leucocytes in cancers of the hematopoietic system (leukemia). In the context of immune diseases cells attack the own body, these can be removed by the Plasmapherese.

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What do you do with an apheresis?

Before any preparative apheresis, the doctor will tell you about the procedure, possible side effects and dangers. In addition, the doctor pays special attention in the history of the medical history (anamnesis) that you have no gastrointestinal diseases, allergies, convulsions, cardiovascular diseases, bleeding tendencies or infections and have enough of their own blood components. Coagulation-promoting drugs must be discontinued one week before the apheresis.

Before the actual apheresis, the doctor usually places needles (hollow needles) in two arm veins of the donor. From one, the donor's blood flows into a closed, sterile and only once usable tube system. There, an anticoagulant (anticogulant) is added to the blood and the mixture is passed into a cell separator. Centrifugation separates the various blood components. In addition, individual substances are obtained by filtration. and the blood is returned to the donor via the other arm vein. The anticoagulant is easily broken down by the liver.

In stem cell apheresis, the stem cells are first stimulated hormonally and flushed out of the bone marrow into the blood.

Therapeutic apheresis is performed like preparative apheresis ... Especially in LDL apheresis or lipid apheresis, the addition of anticoagulants (heparin) or certain antibodies causes binding from the fats to larger structures that can be filtered off.

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What are the risks of apheresis?

Apheresis is a well-tolerated procedure.
During apheresis, a so-called vasovagal reaction may occur. The vessels dilate, the heartbeat slows down and the pressure drops. Typical symptoms include paleness, drowsiness, nausea and irregular breathing. In addition, the puncture site can become infected or it forms a bruise (hematoma). In very rare cases, the degradation of the citrate results in a short-term, acute calcium deficiency, which manifests itself through shivering, tingling in the fingertips, toes, lips or the tongue. The administration of calcium relieves the symptoms and prevents very rarely occurring cardiac arrhythmias.

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