Apheresis is a medical procedure used to remove harmful blood components across different disciplines. This bibliometric analysis evaluated the scientific characteristics of the 100 most-cited articles (T100) with the term "apheresis" in the title published between 1975 and 2025. Data were retrieved from the Web of Science on August 11, 2025, using the keyword "apheresis" in the title field. Among 5765 publications, the T100 articles were identified. Recorded parameters included title, corresponding author, journal, year, total citations, number of authors, adjusted citation index (ACI), and Altmetric score (AmS). Analyses were performed with SPSS 29.0 and VOSviewer. Publication output increased over time, peaking in 2017 (n = 227). The highest number of annual citations occurred in 2024 (n = 2944). Spearman's correlation demonstrated a significant positive relationship between ACI and AmS (r s  = 0.665, p < 0.001). The Journal of Clinical Apheresis contributed the largest share of T100 articles. The United States was the most productive country (30%), while no Turkish publications were included. Schwartz J. was the most cited author, with 2653 citations across five studies. Frequently used keywords were "apheresis" (16%), "plasma exchange" (9%), and "immunoadsorption" (8%). Apheresis research exhibits a dynamic, multidisciplinary structure, with citations peaking years after publication. High-income countries and central institutions dominate scientific output, while contributions from Turkey are absent in the T100. This study highlights key research trends and provides a reference point for future investigations in apheresis.
Red blood cell (RBC) apheresis is, alongside phlebotomy, a standard treatment for iron overload in hereditary hemochromatosis (HH). We compared the serum ferritin (SF) reduction, process parameters, duration, and side effects of two apheresis systems: Spectra Optia apheresis system (Optia) and Alyx apheresis collection system (Alyx). Forty-three patients were RBC depleted with one of the two separators, Optia or Alyx. In total, 186 procedures were performed. The main diagnoses were HH (n = 20) and dysmetabolic iron overload syndrome (DIOS) (n = 21). Around two thirds of the procedures were done with Optia (n = 143) and one third with Alyx (n = 43). A mean volume of 405 and 442 mL of RBCs was withdrawn per single treatment with the Optia and Alyx, respectively. The procedure took 12 min (Optia) versus 26 min (Alyx) with a hematocrit (Hct) reduction of 5% versus 7.5% (p < 0.001). The SF reduction 3 weeks after RBC depletion was not significantly different between the two systems. The amount of anticoagulant used with the Optia was almost half of what was used with the Alyx (63 mL compared to 123 mL). There were no significant adverse events. The advantages of the Alyx include the lower cost and the easy portability. The Optia, on the other hand, has a shorter procedure time, a smaller extracorporeal volume, a lower anticoagulant consumption, a lower rate of complications, and allows a precise Hct adjustment.
The American Society for Apheresis recommends leukapheresis as a category II recommendation for symptomatic hyperleukocytosis. Mortality in these patients varies between 8%-29%. However, no tool is currently available to assess the mortality risk following the procedure. This study aims to assess the factors associated with in-hospital mortality and develop a risk stratification tool consisting of clinically relevant variables to categorize patients based on their mortality risk following the procedure. The National Inpatient Sample Database (2016-2021) and ICD-10 coding were utilized to identify adults with leukemia who underwent leukapheresis. Multivariate logistic regression models were constructed to identify independent factors of mortality. A scoring system was constructed to identify the risks of mortality using the variables in the model and their associated odds ratio (OR). The cumulative risk score was divided into three strata: low (mortality < 20%), intermediate (20%-50%), and high risk (> 50%). Of the estimated 3555 patients who underwent leukapheresis, 40.1% also received chemotherapy. Most patients who underwent leukapheresis had myeloid leukemia (52.2%), followed by lymphoid leukemia (14.2%), monocytic leukemia (6.2%), and the remaining were other types of leukemia. Variables incorporated into the scoring system include: monocytic leukemia, age over 50, morbid obesity, and interventions performed before leukapheresis, such as mechanical ventilation and blood transfusions. The cumulative mortality score ranged from 0 to 30, categorizing patients into high risk (score > 13), intermediate risk (6-13), and low risk (0-5). The risk score demonstrated a performance with an area under the curve of 0.82. A novel simplified scoring tool to predict in-hospital mortality in leukemia patients requiring leukapheresis is presented here. This tool can assist in preprocedural risk assessment, help guide management planning, and consideration of other treatment modalities.
In 2007, the American Society for Apheresis (ASFA) published guidance for physician documentation related to oversight of therapeutic apheresis (TA). Due to 21st century changes in healthcare delivery, the ASFA Board of Directors (BOD) charged its Public Affairs and Advocacy Committee (PAAC) to coordinate a review and update of the guidance. PAAC members reviewed minutes from various ASFA committees' earlier deliberations and sought additional information from the medical and general literature and regulatory/professional organizations involved with medical records documentation as well as from ASFA membership. A draft document was developed, reviewed, and approved by pertinent parties with changes incorporated into the guidance revision. Major change agents impacting TA documentation were identified including the importance of multidisciplinary care teams, the adoption of telemedicine in TA delivery, and the challenges highlighted by the SARS-CoV-2 pandemic. Formats involving TA documentation scenarios related to initial TA consultations and subsequent care activities by TA staff were developed. The introduction of new technologies, the advancing and mandating of electronic medical records (EMRs) adoption and a renewed emphasis on the team-based nature of healthcare delivery have all impacted TA services. Revised documentation formatting practices related to these changes, not only for physicians' involvement but recognition and inclusion of other members of multidisciplinary teams participating in TA, should be incorporated into TA operations. Such revisions can potentially enhance patient care and provide a foundation for TA-related biovigilance activities.
Hematopoietic progenitor cell collection (HPC-C) by apheresis after granulocyte-colony stimulating factor (G-CSF) stimulation is a routine worldwide procedure. The first apheresis procedure is typically performed on Day 5 of G-CSF administration. We aimed to evaluate whether initiating the apheresis procedure on Day 4, with 1 day shorter G-CSF exposure for the donor, affects collection outcomes. This study included healthy, unrelated donors who underwent HPC-C by apheresis after G-CSF administration between April 2022 and February 2024 at our center. Of 182 unrelated donors, 34.6% underwent apheresis on Day 4 of G-CSF treatment and 65.4% on Day 5. There was no significant difference between the two groups in terms of collected CD34+ cell yield (p = 0.369) or the need for a second apheresis procedure (p = 0.74). Successful mobilization was achieved in 93.7% of donors who underwent a single apheresis procedure on Day 4 and in 95% of those who underwent a single apheresis procedure on Day 5 (p = 0.477). In donors requiring two consecutive apheresis procedures, the collected CD34+ cell yield was higher in those who initiated apheresis on Day 4, although this difference was not statistically significant (p = 0.067). This is the first study comparing HPC-C outcomes on Days 4 and 5 of G-CSF administration exclusively in unrelated donors. Our data indicate no difference in the collected CD34+ cell yield or the need for a second apheresis procedure between the two groups. Initiating apheresis on Day 4 may allow for 1 day less G-CSF exposure without compromising collection outcomes.
To review the current role of soluble fms-like tyrosine kinase-1 (sFLT1) and placental growth factor (PlGF) in the pathophysiology, diagnosis, prediction, and treatment of preeclampsia. Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and has increased in prevalence in the United States. It is characterized by new-onset hypertension, proteinuria, and/or end-organ dysfunction, with early-onset disease often associated with placental ischemia, placental insufficiency, and fetal growth restriction. A central mechanism in preeclampsia is angiogenic imbalance, characterized by increased antiangiogenic factors, particularly sFLT1, and reduced proangiogenic signaling mediated by VEGF and PlGF. This review summarizes current evidence regarding sFLT1 biology, the clinical utility of the sFLT1/PlGF ratio, and emerging therapeutic strategies targeting sFLT1 in preeclampsia. sFLT1 is a soluble splice variant of VEGF receptor-1 that binds circulating VEGF and PlGF, thereby promoting endothelial dysfunction, vasoconstriction, and systemic manifestations of preeclampsia. The sFLT1/PlGF ratio has emerged as a clinically useful biomarker, particularly for short-term risk stratification in women with suspected preeclampsia, with strong negative predictive value for ruling out progression to severe disease within 1 to 2 weeks in appropriately selected patients. The ratio has been incorporated into clinical practice in multiple countries and was approved by the US Food and Drug Administration in 2023 for inpatient risk assessment in singleton pregnancies between 23 and 34 weeks and 6 days of gestation with hypertensive disorders of pregnancy. In parallel, therapeutic approaches targeting sFLT1, including small interfering RNA, antibodies, VEGF or PlGF-based molecular strategies, and apheresis, have shown promise in preclinical and early translational studies. sFLT1 is central to the pathophysiology of preeclampsia and has substantial clinical relevance as both a biomarker and a potential therapeutic target. The sFLT1/PlGF ratio is reshaping risk assessment and management of preeclampsia, while sFLT1-directed therapies may offer future disease-modifying treatment options. Further refinement of biomarker-guided use and therapeutic development is needed before broader implementation.
Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy, and 5%-20% of newly diagnosed patients present with hyperleukocytosis (HL). HL, most often defined as WBC > 100 000/μL, is a hematologic emergency associated with severe complications, early mortality, and poor prognosis, requiring immediate intervention. From November 2005 to September 2025, 65 newly diagnosed AML patients with HL underwent leukocytapheresis (LCP) at University Hospital Olomouc. Clinical data were retrospectively collected from medical records. The primary objective was to evaluate the procedural efficacy and safety. Clinical and laboratory data were analyzed. Survival outcomes were assessed by Kaplan-Meier analysis and compared using the log-rank test. Median age at diagnosis was 57 years. Dyspnea (60.0%), neuropsychiatric symptoms (31.7%), and visual impairment (6.2%) were the most common leukostasis manifestations. LCP effectively reduced WBC counts without significant adverse events, median of 2.2 TBV was treated, and 52.3% of the patients requiring more than one session. FLT3-ITD and NPM1 mutations were detected in 26/46 (56.5%) and 17/43 (39.5%), respectively, KMT2A rearrangements were present in 5/57 (8.8%). Intensive chemotherapy was feasible in 56.9% of patients, with 26.2% undergoing allo-HSCT. Median OS was 5.9 months (95% CI: 1.3-8.4), significantly longer in therapy-eligible patients, but outcomes remained poor, highlighting HL as an unmet clinical need. LCP remains a valuable therapeutic option for patients with HL in newly diagnosed AML. Our long-term experience supports its safety and efficacy, particularly in symptomatic patients, as a bridge to definitive therapy regardless of treatment intensity eligibility.
Lipoprotein apheresis (LA) is an established therapy for severe, drug-refractory dyslipidemias. Nevertheless, clinicians often monitor hepatic and muscle enzymes during treatment because transient biochemical shifts can be misinterpreted as injury. In this study, we synthesize the evidence on how repeated apheresis sessions affect circulating enzymes. We systematically searched PubMed, Scopus and Web of Science from inception to August 2025 for observational human studies reporting pre- and post-apheresis values (mean and SD) for aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), lactate dehydrogenase (LDH), and creatine phosphokinase (CPK). Effects were expressed as weighted mean differences (WMD, IU/L). Of 267 records screened, 9 articles (published 1998-2006) met eligibility for quantitative synthesis, yielding 9 ALT, 8 AST, 7 ALP, 6 GGT, 9 LDH and 6 CPK study estimates. Pooled analyses showed significant decreases in AST (WMD = -0.87; 95% CI: -1.51 to -0.23; p = 0.007), ALP (WMD = -6.28; CI: -11.75to -0.80; p = 0.02), LDH (WMD = -11.12; CI: -17.01 to -5.24; p = 0.001) and CPK (WMD = -6.91; CI: -13.06 to -0.75; p = 0.02). However, levels of ALT (WMD = -0.78; CI: -2.10 to 0.53; p = 0.29) and GGT (WMD = -2.64; CI: -8.71 to 3.44; p = 0.39) were unchanged. Across repeated-session studies, LA does not elevate hepatic or muscle injury markers and is associated with modest reductions in AST, ALP, LDH, and CPK. These findings support the biochemical safety profile of apheresis and suggest that routine enzyme monitoring should be interpreted in context.
Dual specialty ports were evaluated for safety and efficacy in therapeutic apheresis by analyzing outcomes across 97 port placement events in 88 patients, focusing on two configurations: dual Bard PowerFlow (BP2) and a combination of Bard PowerFlow with AngioDynamics SmartPort (BP + AD). This retrospective cohort study was conducted at a tertiary care center from December 2017 to July 2024 and included 97 port placement events (194 total ports) across 88 patients with conditions such as bronchiolitis obliterans, sickle cell disease, myasthenia gravis, and graft-versus-host disease who required therapeutic apheresis. Measured outcomes included port revisions, removals, total port days, and complications. The BP2 configuration was used in 43 events (44.3%), and the BP + AD configuration in 54 events (55.7%). Common indications included bronchiolitis obliterans (40.2%), sickle cell disease (17.5%), myasthenia gravis (12.4%), and GVHD (12.4%). Revisions were necessary in 5.7% of ports due to mechanical issues or thrombosis, while 36.1% of ports were removed, mainly due to infection/bacteremia or completion of therapy. Port functionality ranged from 22 to 2080 days, with a mean of 564 days. The mortality rate during follow-up was 21.6%. Dual specialty ports demonstrate viable long-term access for therapeutic apheresis in selected patients, with functionality extending from months to years. Success appears highly dependent on patient selection, with infection risks particularly notable in immunocompromised populations. These findings support the use of specialty ports as an alternative to traditional tunneled catheters, particularly for those with preserved immune function requiring chronic therapy.
Successful hematopoietic stem cell transplantation relies on the collection of a sufficient number of CD34+ hematopoietic progenitor cells (HPCs). While acid citrate dextrose solution A (ACD-A) is a common anticoagulant (AC) for HPC apheresis [HPC(A)], recent evidence suggests that concomitant heparin may enhance intra-apheresis recruitment (IAR) of CD34+ cells and improve collection efficiency. This study aimed to compare citrate-only and citrate-heparin protocols in routine HPC(A) procedures, with a focus on their effects on IAR and efficiency outcomes. A retrospective analysis was performed on 266 HPC(As) from 193 apheresis donors in autologous and allogeneic settings. Donor demographics, procedural parameters, and collection outcomes were compared between the ACD-A-only and ACD-A plus heparin protocols. The study endpoints included apheresis yield (AY/kg), collection efficiencies (CE1, CE2, and cruCE), recruitment ratio (RR), and performance ratio (PR). Statistical analyses included Mann-Whitney U tests, effect sizes, and partial least squares (PLS) regression. Heparinized procedures demonstrated higher processed total blood volume ratios, lower AC volumes, and superior outcomes across CE1 (83.8% vs. 72.5%, p = 0.00027), CE2 (70.8% vs. 64.2%, p = 0.0055), cruCE (77.0% vs. 72.4%, p < 0.0001), RR (2.3 vs. 1.7, p < 0.0001), PR (239.3% vs. 208.2%, p < 0.0001), and AY/kg (6.75 vs. 5.23 × 106 CD34+ cells/kg, p = 0.0025). The effect size and PLS analyses confirmed the contribution of heparin as an adjunct AC enhancing multiple apheresis outcomes. In summary, citrate-heparin anticoagulation was found to be a feasible strategy that improved key collection efficiency and IAR metrics during HPC(A).
Advances in the understanding of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) pathophysiology have expanded the application of plasma exchange (PE) in severe cases; however, robust evidence on its efficacy, safety, and long-term outcomes remains scarce. This retrospective study evaluated the short-term efficacy, safety, and long-term prognosis of PE in patients with severe AAV. A total of 24 patients receiving PE alongside standard induction therapy (glucocorticoids plus cyclophosphamide or rituximab) were analyzed. Clinical and laboratory parameters-including ANCA titers, Birmingham Vasculitis Activity Score (BVAS), C-reactive protein (CRP), and hemoglobin (Hb)-were assessed before and after treatment, together with adverse events and survival. The cohort comprised 10 males and 14 females, mean age 62.5 ± 16.1 years (range 29-84). PE was associated with significant reductions in ANCA levels, BVAS, and CRP, alongside increased Hb. Over long-term follow-up, mortality rose progressively, mainly attributable to severe infections, respiratory failure, and heart failure. In conclusion, PE exhibits short-term effectiveness and a tolerable safety profile in severe AAV, yet long-term survival outcomes warrant further attention.
Lipoprotein apheresis is a well-established therapy for patients with dyslipidemia unresponsive to conventional lipid-lowering strategies. However, its impact on systemic inflammation remains uncertain. This systematic review and meta-analysis evaluated the effect of apheresis on circulating inflammatory markers, including C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Following PRISMA guidelines, a systematic search of PubMed, Scopus, and ISI Web of Science was conducted up to June 2025. Studies reporting pre- and post-apheresis values for inflammatory markers were included. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Thirteen publications met inclusion criteria. Meta-analysis demonstrated that apheresis significantly reduced CRP levels (SMD = -0.31; 95% CI: -0.44 to -0.18; p < 0.001), particularly in long-term interventions. No significant changes were observed for IL-6, TNF-α, or hs-CRP. In conclusion, apheresis significantly reduces CRP levels, especially with long-term treatment, suggesting a modest anti-inflammatory benefit. However, its effects on other markers remain unclear. Larger and high-quality trials are warranted.
In this study we analyzed 12 years of adverse events, (AE) data from the World Apheresis Association, (WAA) Registry specific to the Spectra Optia Apheresis System. We queried WAA Registry data, (2012-2023) on apheresis procedures performed exclusively on the Spectra Optia Apheresis System. We categorized AEs by severity, (mild, moderate, and severe), and ordered them by year. We then analyzed and presented AEs associated with the following variables: diagnosis, procedure type, vascular access, and replacement fluid type, and causes of procedural interruption. We identified 51 567 apheresis procedures specific to the Spectra Optia Apheresis System within the data set. AE rates from 2012 to 2023 for mild, moderate, and severe were 1.43%, 2.81%, and 0.21%, respectively. Procedures associated with the lowest AE rates include red blood cell exchange and therapeutic plasma exchange. The most common mild and moderate AEs include tingling and hypotension and AEs related to vascular access. The highest rates of mild and moderate AEs were associated with cellular collections. The highest rate of severe AEs was associated with the use of 3.5% albumin as replacement fluid. Other variables impacting patient safety are identified. AE rates could not be compared to the median length of procedure since this time variable is not currently collected in the Registry. This is the first device-specific analysis of the WAA Registry data, bringing prior safety reporting into even sharper focus. Device-specific safety analysis like this will help practitioners better understand potential safety concerns associated with a commonly used apheresis device, including various separation modalities and accessories, thus supporting improved procedure management.
The objective of this in vitro experimental was to determine the utility of hemoadsorption (HA) using the CytoSorb adsorber to remove meloxicam and diclofenac from porcine plasma. For this purpose 12 1-L aliquots of porcine plasma, 6 units were spiked with 293 μg/mL (262-320 μg/mL) diclofenac and 6 with 42.8 μg/mL (41.4-44.7 μg/mL) meloxicam, respectively. Each unit was processed in a circular setup with the CytoSorb adsorber using the PuriFi HA platform until a recirculated volume of 20 L was reached. Pre- and post-adsorber samples were obtained at seven time points. Percentage reduction, clearance, and change from baseline were calculated. Drug concentrations were compared using Friedmann test with post hoc Dunn's multiple comparison test and Wilcoxon matched pairs rank sum test. p < 0.05 were considered significant. Diclofenac was reduced by a median of 242 mg (204-262 mg; 82.1%; 77.0%-83.6%). Total clearance was 40.5 mL/min (33.2-46.2 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 39.9 mL/min (25.3-46.6 mL/min) at 0.2 L to 6.4 mL/min (-3.8 to 14.8 mL/min) at 20 L. Median reduction of meloxicam was 40.4 mg (38.6-42.2 mg; 94.4%; 93.2%-94.6%); total clearance was 94.38 mL/min (93.2-94.6 mL/min). Clearance at a plasma flow of 100 mL/min decreased from 65.3 mL/min (56.7-71.7 mL/min) at 0.2 L to 3.6 mL/min (-13.0 to 4.2 mL/min) at 20 L. HA using the CytoSorb adsorber successfully removed meloxicam and diclofenac from porcine plasma.
There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice.
While lipoprotein apheresis (LA) is established for lipid management in primary biliary cholangitis, the role of apheresis techniques in drug-induced cholestatic liver disease remains unexplored. We report the novel application of double filtration plasmapheresis (DFPP) for rapid reversal of severe hypercholesterolemia in iatrogenic cholestasis, where conventional therapies failed or were contraindicated. A 56-year-old male developed severe cholestatic hepatitis following the use of herbal agents. Laboratory investigation revealed extreme hypercholesterolemia, with a total cholesterol (TC) of 41.39 mmol/L and a low-density lipoprotein cholesterol (LDL-c) of 38 mmol/L. Standard medical therapy proved ineffective. Two sessions of DFPP resulted in > 90% reduction in cholesterol levels and simultaneous improvement in bilirubin and liver enzymes, with sustained normal levels at 1-year follow-up. DFPP may serve as a novel rescue therapy for drug-induced cholestatic hypercholesterolemia, providing simultaneous removal of cholesterol and bilirubin where other treatments are ineffective or at high risk.
People are increasingly using artificial intelligence (AI)-based chatbots to provide health-related information. However, concerns remain regarding the quality, accuracy, and readability of the information they produce. This study aimed to evaluate and compare the responses of five widely used AI chatbots to the most frequently searched keywords about apheresis. On May 1, 2025, the 25 most searched apheresis-related keywords were identified using Google Trends. Two keywords were excluded due to irrelevance. The remaining 23 queries were submitted to five chatbots: GPT-4o, Gemini 2.5, Grok 3, DeepSeek v3, and Copilot. Responses were assessed using the EQIP tool for content quality, the DISCERN questionnaire for information reliability, and the Flesch-Kincaid grade level (FKGL) and reading ease (FKRE) metrics for readability. Statistical analysis was performed using the Kruskal-Wallis test and Bonferroni correction. Significant differences were found among chatbots in EQIP, DISCERN, FKGL, and FKRE scores (p = 0.001). DeepSeek v3 demonstrated the highest quality and accuracy (EQIP: 95.7%, DISCERN: 71.8), while GPT-4o had the best readability (FKRE: 43.1, FKGL: 9.1). Copilot showed the poorest readability. Overall, chatbot responses were generally written at a college reading level. AI chatbots vary substantially in the quality and comprehensibility of their health information about apheresis. While newer models like DeepSeek offer improved informational accuracy, readability remains a concern across all platforms. Future chatbot development should prioritize plain-language communication to enhance accessibility and health literacy for diverse patient populations.
Autologous peripheral blood stem cell (PBSC) collections are routinely performed in the outpatient setting and typically involve placement of an apheresis-compatible central venous catheter (CVC). There is reluctance to discharge outpatients with non-tunneled CVCs due to safety concerns. We characterized our center's practice of multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous PBSC collections. No patient with social, cognitive, hygienic, caregiver, or bleeding concerns had non-tunneled CVC placement. All patients and caregivers were counseled about potential risks of non-tunneled CVCs and were provided with basic CVC care education. In total, 117 autologous PBSC collections were performed in 65 adult outpatients via non-tunneled CVCs. Apheresis nursing staff removed CVCs from all patients on their final PBSC collection day. There was one minor CVC site bleed that was successfully controlled with manual compression. In our small population, multiday non-tunneled CVC use in vetted adult outpatients undergoing autologous PBSC collections was feasible and well tolerated.
The American Society for Apheresis (ASFA) guidelines serve as a global standard for therapeutic apheresis practice. However, our analysis of the 2023 guidelines reveals discordance between the strength of recommendation and the quality of evidence. Among 166 indications, one-third carry strong recommendations, yet only 8% are supported by high-quality evidence. Over half (55%) are informed by low- or very-low quality evidence. This mismatch is most pronounced for Category I indications, where apheresis is considered first-line therapy: nearly one-third are based on low-quality data, yet 89% receive strong recommendations. Weak evidence is nine times more likely to prompt a strong recommendation for Category I versus Category III indications. This misalignment risks overutilization of apheresis, introduces ethical hurdles for clinical trials by diminishing equipoise, and may mislead patient expectations during informed consent. We advocate for greater transparency by stating the rationale underlying strong recommendations despite low-quality evidence, acknowledgment of uncertainty where applicable, and suggested research to strengthen the evidence.
Immunoadsorption selectively eliminates circulating antibodies in antibody-mediated diseases. Iron deficiency is the most common cause of anemia; however, the potential role of immunoadsorption in contributing to iron depletion remains insufficiently established. This study quantified levels of eluted iron, ferritin, and transferrin in the regeneration solutions of peptide ligand adsorbers from 13 patients and in ABO antigen-specific non-regenerative adsorbers from five patients. Markers of anemia and iron status were assessed at baseline and monitored for up to 2 weeks. Analysis of regeneration solutions from regenerative adsorbers revealed considerable levels of eluted iron (5.46 ± 7.4 μg/dL in NaCl 0.9%; 1.46 ± 1.45 μg/dL in glycine, and 3.61 ± 6.07 μg/dL in PBS), ferritin (52.65 ± 96.14 ng/mL in NaCl 0.9%; 18.79 ± 46.44 ng/mL in glycine and 4.93 ± 14.79 ng/mL in PBS), and transferrin (0.168 ± 0.26 g/L in NaCl 0.9%; 0.594 ± 2.37 g/L in glycine, and 0.005 ± 0.02 g/L in PBS). In ABO adsorbers, 50.27 ± 22.66 μg/dL iron, 88.39 ± 33.21 ng/mL ferritin, and 1.165 ± 0.41 g/L transferrin were detected, implicating adsorbers to directly deplete iron-related proteins. Blood hemoglobin (-1.88 g/dL), erythrocyte count (-0.58 × 1012/L), hematocrit (-5.32%), and MCH (-0.53 pg), as well as iron (-10 μg/dL) and ferritin (-22.3 ng/mL) levels were decreased at the final visit. These findings demonstrate that immunoadsorption contributes to the depletion of iron-related proteins from plasma, with adsorbers playing a pivotal role in iron loss. This highlights the need for vigilant monitoring of iron parameters and potential mitigation strategies in immunoadsorption patients.