Draft:TPE 1

Therapeutic Apheresis
Therapeutic Apheresis refers to the process of using an apheresis machine to treat certain diseases in patients whether in the hospital or in an outpatient clinic setting. The blood in humans consists of a cellular portion and a non-cellular portion. The cellular part is divided into red cells, white cells and platelets. The non-cellular portion is called plasma. When an apheresis machine is used to remove a portion of the blood and replace it with a substitute, that is called "exchange". The oldest and most common type of Therapeutic Apheresis is called plasma exchange often called Therapeutic Plasma Exchange (TPE). TPE is used to treat patients with pathogenic substances in their plasma that are causing disease and replace it with a plasma substitute generally 5% Albumin. TPE is used currently to treat more than 117 clinical disease states and is an FDA approved procedure. The American Society for Apheresis (ASFA) panels a committee of experts who then publish Guidelines on the Use of Therapeutic Apheresis in Clinical Practice, which are evidence based. This ASFA guidelines are generally followed by Transfusion Medicine physicians in their use of TPE in treating disease. The ASFA guidelines present clinical conditions for which TPE is recommended and the evidence and level of quality of that recommendation. The ASFA guidelines also break all the TPE treatable conditions into category grades I-IV with category I being the highest level indication where TPE is the only or the best option for treatment. Category II means TPE is used alongside another modality such as medical therapy. Category III means there is evidence to show that TPE is effective in that condition. Category IV means that TPE is generally contraindicated for that particular condition.

If an apheresis machine is used to remove red cells and replace them with donor red cells, that process is called Red Cell Exchange (RCE). If white cells or platelets are removed that is referred to as White Cell Reduction or Platelet Reduction respectively. The ASFA guidelines list these procedures and their respective category indication as well for a given disease state treated.

Sometimes, Therapeutic Apheresis may be used to perform a filtration or a treatment of cells outside of the body and then return the filtered blood or treated cells back to the body. Examples of this are lipidphresis where the blood is washed over a column that removed unwanted substances like LDL cholesterol. Extracorporeal Photopheresis refers to the treatment of white cells with UV light inside an apheresis machine and then returning those treated cells back to the patient, something which has been shown to help in graft versus host disease. There are also published cases of TPE being used for drug removal if the drug is present in the plasma in high enough concentration.

APHERESIS PROCESS
In patients who have diseases that need to be treated with TPE

PERSONEL
OTHER

TPE is often confused with dialysis. Has been used for drug removal and sepsis.

In most states TPE must be performed by a qualified apheresis nurse with supervision by a Transfusion Medicine Physician or one that has completed Fellowship training in Transfusion Medicine.