Leukapheresis

Leukapheresis

Leukapheresis is a laboratory procedure in which white blood cells are separated from a sample of blood. This may be done to decrease a very high white blood cell count in individuals with cancer (leukemia) or to remove white blood cells for transfusion. In the case of cancer, usually hematological malignancies such as acute leukemias, there are white blood cell counts high enough to cause hemostasis and "sludging" in the capillaries. This can effect retinal vasculature leading to vision changes, pulmonary vasculature leading to shortness of breath from decreased efficiency in oxygen exchange, as well as other organ systems such as the brain which would become clinically apparent with neurological deterioration of a patient from cerebrovascular compromise.

Alternatively, only granulocytes, macrophages and monocytes can be removed, leaving the lymphocyte count largely unchanged. This is used as a treatment for autoimmune diseases such as ulcerative colitis and rheumatoid arthritis, where these cells play an active part in the inflammation process.

Leukapheresis, typically for granulocytes, is a rarely performed blood donation process. The product is collected by automated apheresis and is used for systemic infections in patients with neutropenia. The donor is typically a blood relative who has received stimulating medications (a directed donation), and the product is irradiated to prevent GVHD. The product generally has a 24 hour shelf life from collection and is often transfused before infectious disease testing is completed. It is a therapy of last resort, and its use is controversial and rare.

References

* Cite journal
author = G Hahn, B Stuhlmüller, N Hain, J R Kalden, K Pfizenmaier, and G R Burmester
year = 1993
url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=288038&tools=bot
title = Modulation of monocyte activation in patients with rheumatoid arthritis by leukapheresis therapy
journal = The Journal of Clinical Investigation
volume = 91
pages = 862–870
doi = 10.1172/JCI116307
pmid = 8450066
* National Institute for Health and Clinical Excellence, [http://scholar.google.com/url?sa=U&q=http://pdf.giofil.it/circopdf/vy00.pdf Leukapheresis for inflammatory bowel disease] (guidance). Retrieved Oct. 06 2005
* [http://www.fda.gov/cber/gdlns/crclr.pdf Circular of Information for Blood Products]


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