There are four forms of apheresis therapy offered at Nationwide Children’s Hospital:
Red Cell Exchange:
This procedure is generally used to treat patients with Sickle Cell disease who are acutely ill from a stroke or need chronic transfusions in order to prevent a stroke or other complications. It has also been used successfully in patients with malaria and other diseases that attack the red blood cells such as babesiosis. The damaged red blood cells are removed and replaced with healthy red cells. In a related procedure- patients with iron overload or hemochromatosis from inherited or acquired conditions can also be treated with red cell exchange – however their removed red cells are replaced with substitute solutions like saline or albumin.
Therapeutic Plasma Exchange (TPE):
This method of apheresis therapy is used to remove plasma from the blood of children with diseases and disorders and replace them with donor plasma, albumin or a combination of the two. Therapeutic plasma exchange is often used for children with Neurological conditions such as Guillain Barre syndrome, Myasthenia Gravis and inflammatory polyneuropathies among others; kidney disorders such as HUS, focal segmental glomerulosclerosis, rejection of a transplanted kidney, Good pasture syndrome; Septic patients in the ICU who need plasma products to either supplement their care or provide deficient plasma proteins to them in a safe manner; but who are unable to handle high volumes of blood. There are several more and evolving indications for plasma exchange including acute and chronic hyperlipidemias, autoimmune disorders and rare neuro-inflammatory conditions which are being actively studied.
Leukopheresis or leucodepletion:
This apheresis procedure is used to reduce the morbidity from a high cell count in children with cancers like high risk leukemia or chronic myeloid leukemia. It involves removal of the abnormally large number of white cells that can complicate the disease and may be life threatening. The second type of leukopheresis allows for collection of stem cells from the blood, to be frozen and stored and which are later returned to a cancer patient during a stem cell transplant. This type of stem cell harvesting is used for autologous donors as described above but also for family or unrelated donor harvests when donors are unfit for bone marrow harvest, prefer not to undergo a bone marrow harvest, or if their stem cells are being used for cellular therapies. There are many evolving indications for this procedure.
Extracorporeal photopheresis (ECP):
Extracorporeal photopheresis is a novel and recently introduced procedure that is used to treat conditions like graft versus host disease, graft rejection of transplanted solid organs such as the heart or lung and certain rare skin cancers. It involves the separation of the buffy coat of a patient’s blood containing their mononuclear cells (lymphocytes mainly); and treating these cells in a closed system with a psoralen (a light sensitizer) and subsequently by exposing these treated cells to ultraviolet light (UVA) radiation in order to modulate the immune system. These cells then can be returned to the patient shortly after this photoactivation. Depending on the condition of the patient- ECP can be performed as an inpatient but can also be performed as an outpatient.