Apheresis techniques and

principles

Dr. Hans Vrielink, MD, PhD

Apheresis
Aphairesis (ἄφαιςεσοσ)
• To take away

Technique to collect solely the blood component requested.

The remainder blood components are returned to the donor or

patient.
 Aferese in historische geneeskunde
Disease reflects presence of
disease-causing factors in the
blood; selective blood letting
(apheresis) should initiate cure.

Hippocrates (460-377 BC)

Claudius Galen (129-216 AD)
Apheresis
•1877 De Laval
Apheresis
•1877 De Laval
•1951 Cohn
Apheresis
•1877 De Laval
•1951 Cohn
•195? Latham
Apheresis
•1877 De Laval
•1951 Cohn
•195? Latham
•1965 NCI-IBM 2990
Apheresis
•1877 De Laval
•1951 Cohn
•195? Latham
•1965 NCI-IBM 2990
•1969 Celltrifuge I
Apheresis
•1877 De Laval
•1951 Cohn
•195? Latham
•1965 NCI-IBM 2990
•1969 Celltrifuge I
•1973 Celltrifuge II → Fenwall CS3000 (1979)
Aferese
•1877 De Laval
•1951 Cohn
•195? Latham
•1965 NCI-IBM 2990
•1969 Celltrifuge I
•1973 Celltrifuge II → Fenwall CS3000 (1979)
•1975 IBM 2997
Apheresis equipment
• Fenwal
• Fresenius
• Gambro
• Haemonetics
• ……….
Apheresis equipment
Apheresis techniques
•Plasmapheresis

•Cytapheresis
-Plateletapheresis
-Stem cell apheresis
-Lymphocytapheresis
-Monocytapheresis
-Granulocytapheresis
-Erytrocytapheresis

•Multicomponent apheresis Transfusion August 2000

Apheresis
•Donors •To achieve blood components

•Patients •To achieve blood components

•To reduce blood components
Therapeutic Apheresis

Why?

In most cases reduction

of symptoms !
Principle of Apheresis
Apheresis
Technique to collect solely the blood component requested.

The remainder blood components are returned to the donor or

patient.
Principle apheresis
Filtration techniques

Centrifugal techniques
Principle apheresis
Filtration techniques

Centrifugal techniques

Combinations
Apheresis equipment
Apheresis disposables Haemonetics
•622, 623, 782, 792 •Plasmapheresis
•944, 948 •RBC apheresis
•970, 971 •WBC apheresis
•980, 981 •Plasmaexchange
•994 •Plateletapheresis
Apheresis disposables
Open systems

Closed systems
Open vs. closed systems
Clotting during apheresis
•Citrate solutions
•Sodium-citrate
•ACD-A
•CPD
Clotting
Clotting during apheresis
• Citrate solutions
•Sodium-citrate
•ACD-A
•CPD
• Heparin
Clotting
Separation of blood components
• Separation based on the presence of cells
• Separation based on specific gradients
Blood

  Specific weight Size

Plasma 1,026
Trombocytes 1,040 1-4 μm
Lymphocytes 1,050-1,061 6-10 μm
Monocytes 1,077 10-30 μm
Basophils 1,080 10-15 μm
Eosinophils 1,082 9-15 μm
Neutrophils 1,088 12-15 μm
Erytrocytes 1,100 6-8 μm
Blood
Plasma

Platelets

Leukocytes

Erytrocytes
Centrifugal separation Haemonetics
Draw
Draw (continued)
Draw (continued)
Detection of cells
Draw (end)
Return
Return continued
Sensors
Apheresis techniques
•Plasmapheresis

•Cytapheresis
-Plateletapheresis
-Stemcellapheresis
-Granulocytapheresis
-Erytrocytapheresis

•Multicomponent apheresis
Cytapheresis
Blood

  Specific weight Size

Plasma 1,026
Trombocytes 1,040 1-4 μm
Lymphocytes 1,050-1,061 6-10 μm
Monocytes 1,077 10-30 μm
Basophils 1,080 10-15 μm
Eosinophils 1,082 9-15 μm
Neutrophils 1,088 12-15 μm
Erytrocytes 1,100 6-8 μm
Separation in system

Plasma
Trombocytes
Lymphocytes
Monocytes
} Granulocytes

Erytrocytes
Separation
MCS protocol cards
•LDP Platelets
•PPP/FFP Plasma
•SDR RBCs
•PBSC WBCs
•TPE Plasmaexchange
MCS+ & Plateletapheresis
Apheresis of blood components
• Centrifuge speed
• Sensors
Parameter settings
• Start Collect at
• Stop Collect at
• RBC Detect at
• Volume into RBC
 0
500
1000
1500
2000
2500
3000
3500
4000
0
160
320
480
640
800
960
1120
1280
1440
1600
1760
1920
2080
2240
2400
2560
2720
2880
3040
3200

B O4
3360
3520
3680
MCS+: line sensor signal

LS 4
3840
4000
4160
4320
4480
4640
4800
4960
5120
5272
5432
5592
5752
5912
6072
time

6232
6392
25%
50%

6552
100%

6712
6872
 1000
1500
2000
2500
3000
3500

500

0
4690
4720
4750
4780
4810
4840
4870
4900
4930
4960
4990
5020
5050
5080
5110
5140
5170
5200

LS 4
5230
5252
5282
MCS+: line sensor signal

25%
5312
5342
5372
5402

20%
5432
5462
5492

15%
5522
5552
5582
5612
5642
5672
5702
5732
5762
5792
5822
5852
5882
5912
5942
5972
6002
Cell selection
ALD & apheresis
Centrifuge system

Filter

LRS chamber
Apheresis
• Plasma Clottingfactors
• RBCs Oxigen transport
• Platelets Hemostasis
• Stem Cells Replacement
• Lymfocytes GvL
• Granulocytes Severe infections
• (combinations)
Apheresis principles
• How to separate whole blood
• Open / closed apheresis systems
• Plasmapheresis / cytapheresis principles
• Leukodepletion and apheresis