Evidence-graded clinical guidance based primarily on American Society for Apheresis (ASFA) guidelines and major peer-reviewed reviews, covering 106 disease conditions, all major apheresis procedures, and 14 clinical calculators — curated for clinicians and patients.
This reference serves clinicians, students, and patients. Choose your path for a tailored experience.
ASFA categories, GRADE evidence, procedure protocols, replacement fluid selection, and anticoagulation guidance.
Learn how apheresis works, understand the technology, and explore the evidence framework behind clinical decisions.
Plain-language explanations of what apheresis is, what to expect during treatment, and how to prepare.
Therapeutic apheresis is a family of medical procedures that remove blood from a patient, separate it into components using centrifugal or membrane-based technology, selectively remove or modify one or more components, and return the treated blood to the patient.
Unlike simple blood transfusions, apheresis allows clinicians to precisely target and remove pathogenic substances — such as autoantibodies, abnormal lipoproteins, malignant cells, or toxins — that drive disease.
Clinical decision-making in apheresis is largely guided by the American Society for Apheresis (ASFA), which publishes evidence-based guidelines classifying indications into four categories and grading the underlying evidence using the GRADE methodology. ASFA is a professional society, not a regulatory authority.
Each procedure targets a specific blood component or pathogenic substance.
Removes and replaces patient plasma, eliminating circulating autoantibodies, immune complexes, and toxins. One of the most commonly performed therapeutic apheresis procedures worldwide.
Selectively removes and replaces patient red blood cells with donor cells. Used in sickle cell disease for severe complications such as stroke, acute chest syndrome, and multiorgan failure, and as an adjunctive therapy in selected cases of severe falciparum malaria.
Treats mononuclear cells with a photoactive compound and UVA light before reinfusion. FDA-approved for advanced cutaneous T-cell lymphoma; widely used and guideline-supported for steroid-refractory chronic graft-versus-host disease (off-label in the U.S.).
Selectively removes low-density lipoproteins from plasma. Classified as ASFA Category I for homozygous familial hypercholesterolemia (HoFH) and Category II in heterozygous FH (HeFH) when maximal medical therapy is insufficient.
Passes plasma through a column that selectively binds immunoglobulins or specific antibodies. Can process 2–3 plasma volumes without replacement fluid.
Selectively removes white blood cells to rapidly reduce leukocyte burden in hyperleukocytosis, particularly when leukostasis causes respiratory or neurologic compromise. Used as an adjunct to cytoreductive chemotherapy rather than a standalone curative therapy.
Category I — first-line apheresis therapy with the strongest evidence.
Life-threatening thrombotic microangiopathy caused by ADAMTS13 deficiency. TPE is the cornerstone of treatment, rapidly removing auto-antibodies and replenishing the enzyme.
Acute inflammatory demyelinating polyneuropathy causing ascending paralysis. TPE was the first modality proven effective in major RCTs. In severely affected AIDP patients, TPE and IVIg have demonstrated equivalent outcomes — this equivalency applies specifically to severe AIDP and does not extend to all GBS variants.
Genetic disorder causing severely elevated LDL-cholesterol. LDL apheresis is Category I first-line therapy when maximal drug treatment is insufficient, with long-term studies demonstrating LDL-C reduction, cardiovascular event prevention, and stabilization or regression of coronary atherosclerosis.
Rapidly progressive glomerulonephritis caused by anti-glomerular basement membrane antibodies. TPE rapidly clears circulating antibodies to prevent irreversible renal damage.
Autoimmune neuromuscular junction disease. TPE rapidly removes acetylcholine receptor antibodies, providing short-term improvement for myasthenic crisis or pre-surgical optimization.
RBC exchange reduces sickle hemoglobin percentage rapidly, halting stroke progression and preventing recurrence. Preferred over simple transfusion to avoid iron overload.
Key statistics from Apheresis Reference — grounded in ASFA guidelines and current apheresis evidence.
With over 22 neurological indications, the nervous system represents one of the most important application domains for therapeutic apheresis. Many of these conditions — GBS, MG, CIDP, NMDA encephalitis — involve pathogenic autoantibodies that plasma exchange can effectively remove.
The ASFA Neurological Practitioner's guide provides specialized protocols for common and rare neuroimmunological conditions, including detailed frequency, volume, and replacement fluid recommendations.
Neurological Indications →Clinical Disclaimer: This website is intended for educational and informational purposes only. Content reflects published ASFA guidelines and current apheresis evidence but does not constitute medical advice. Therapeutic decisions require individualized clinical judgment by qualified healthcare professionals. Some Category III and IV indications remain controversial — guidelines should be interpreted in the context of the individual patient.