The selective removal of white blood cells from the circulation for therapeutic purposes. Encompasses cytoreductive leukapheresis for hyperleukocytosis in hematologic malignancies, and adsorptive granulocyte/monocyte apheresis for inflammatory bowel disease.
Used to rapidly reduce a dangerously elevated white blood cell count in patients with hematologic malignancies (leukemia). The procedure removes large numbers of circulating leukemic blasts or mature leukocytes to prevent or treat leukostasis — a life-threatening complication of hyperleukocytosis.
A specialized form of leukapheresis used in inflammatory bowel disease (Crohn's disease and ulcerative colitis). Blood passes through a column packed with cellulose acetate beads that selectively adsorb activated granulocytes and monocytes — the inflammatory cells driving intestinal damage.
In hyperleukocytosis, the white blood cell count exceeds 100,000/µL, dramatically increasing blood viscosity. Leukemic blasts are larger and less deformable than normal red blood cells, causing them to aggregate in small vessels and obstruct microvascular flow — a condition called leukostasis.
Leukostasis can cause life-threatening complications including pulmonary infiltrates with respiratory failure, cerebral infarction, retinal hemorrhage, and priapism. Cytoreductive leukapheresis uses centrifugal separation to rapidly remove the leukocyte-enriched buffy coat layer, reducing the circulating blast count by 30–50% per session.
Importantly, leukapheresis is a temporizing measure — it does not treat the underlying malignancy. It is used as a bridge to allow chemotherapy to be initiated safely, reducing the risk of tumor lysis syndrome and leukostasis complications during induction therapy.
In active inflammatory bowel disease, activated granulocytes and monocytes infiltrate the intestinal mucosa and release inflammatory mediators — reactive oxygen species, proteases, and cytokines — that perpetuate mucosal damage and prevent healing.
Adsorptive GMA uses cellulose acetate bead columns (Adacolumn®) that selectively capture activated CD10-positive granulocytes and CD14+/CD16+ monocytes through complement-mediated and Fc receptor-mediated mechanisms. By removing these activated inflammatory cells from circulation before they can migrate to the gut, GMA reduces the inflammatory burden in the intestinal mucosa.
GMA has a favorable safety profile with minimal systemic immunosuppression, making it particularly attractive for patients who have failed or cannot tolerate conventional immunosuppressive therapy.
| Condition | Category | Grade | Notes |
|---|---|---|---|
| Leukostasis — Symptomatic | I | 1B | Emergency cytoreduction; bridge to chemotherapy |
| Hyperleukocytosis — Prophylactic | II | 2C | WBC >100K without symptoms; risk reduction |
| Inflammatory Bowel Disease (GMA) | III | 2B | Steroid-refractory UC/Crohn's; adsorptive GMA |