Therapeutic Apheresis Applications in Critical Care

Therapeutic apheresis encompasses a spectrum of extracorporeal procedures designed to remove pathogenic substances or to replenish deficient components in critically ill patients. In intensive care settings, plasma exchange, haemoadsorption and cellular apheresis target conditions such as severe autoimmune disorders, hyperviscosity syndromes, drug toxicity and cytokine storm in sepsis. Procedures are tailored according to patient weight and haematocrit, with anticoagulation strategies optimised to balance clotting and bleeding risks. Device choice—membrane versus centrifugal systems—affects processing time, plasma removal efficiency and cell loss. Close monitoring of electrolytes, particularly calcium during citrate anticoagulation, and real-time assessment of coagulation parameters are essential to mitigate complications. Emerging applications in critical care include removal of inflammatory mediators in acute respiratory distress syndrome and plasma exchange as adjunctive therapy in refractory neurological crises. Globally, apheresis units are standardising protocols to improve safety, expand indications and integrate point-of-care diagnostics to guide personalised treatment regimens.

Research from Nature Portfolio

Recent studies have examined calcium homeostasis during high-volume leukapheresis for cellular therapies. Investigators recorded ionised calcium levels before, immediately after and one hour following leukapheresis in patients undergoing chimeric antigen receptor T-cell and stem cell collection. They observed that rapid infusion of calcium gluconate coupled with large processing volumes relative to body weight led to post-procedure hypercalcaemia. Based on multivariate regression, a predictive algorithm was developed to estimate ionised calcium concentration one hour post-procedure. This tool guides clinicians on optimal blood processing rates and calcium supplementation schedules, reducing hypocalcaemia during treatment without precipitating delayed hypercalcaemia.

Therapeutic Apheresis Applications in Critical Care publication trend

The graph below shows the total number of articles in therapeutic apheresis applications in critical care across all publications each year (not limited to Nature Index journals).

Technical terms

Apheresis: Extracorporeal separation and removal of blood components for therapeutic purposes.

Therapeutic plasma exchange (TPE): Removal of plasma containing pathological factors and replacement with donor plasma or solution.

Leukapheresis: Selective extraction of white blood cells for cellular therapies or to reduce leukocyte-mediated toxicity.

Distribution volume: Apparent volume in which a drug disperses, influencing its removal during apheresis.

Haematocrit: Proportion of blood volume occupied by red cells, affecting calculation of plasma exchange dose.

References

1. Risk analysis of fluctuating hypercalcemia after leukapheresis in cellular therapy. Scientific Reports (2023).
2. Membrane versus centrifuge-based therapeutic plasma exchange: a randomized prospective crossover study. International Urology and Nephrology (2015).
3. Assessment of Hemostasis after Plasma Exchange Using Rotational Thrombelastometry (ROTEM). PLOS ONE (2015).
4. Therapeutic plasma exchange in a tertiary care center: 185 patients undergoing 912 treatments - a one-year retrospective analysis. BMC Nephrology (2018).
5. Is Antimicrobial Treatment Effective During Therapeutic Plasma Exchange? Investigating the Role of Possible Interactions. Pharmaceutics (2020).
6. Research priorities for therapeutic plasma exchange in critically ill patients. Intensive Care Medicine Experimental (2023).