If your doctor has recommended apheresis treatment, this guide will help you understand what it is, what happens during the procedure, and what to expect before, during, and after your sessions.
Apheresis (pronounced ay-fuh-REE-sis) is a medical procedure where your blood is removed from your body, separated into its different parts, and a specific part that is causing problems is removed or changed. The rest of your blood is then returned to your body.
Think of it like a filter for your blood. Just as a water filter removes impurities while letting clean water through, apheresis removes specific harmful substances from your blood — such as abnormal antibodies, excess cholesterol, or diseased cells — while returning everything else safely to you.
The procedure is performed using a specialized machine that processes your blood outside your body and returns it within minutes. You are awake throughout — most patients watch TV, read, or sleep during the session.
Good to Know: Apheresis is not chemotherapy or radiation. It does not use drugs to fight disease. Instead, it physically removes the harmful substance causing your condition — often providing faster relief than medication alone.
Removes the liquid part of your blood (plasma), which contains harmful antibodies or toxins. Replaced with a safe substitute (albumin or donor plasma).
Used for: TTP, Myasthenia Gravis, Guillain-Barré, and many others.
Removes your red blood cells and replaces them with healthy donor red blood cells.
Used for: Sickle cell disease, severe malaria.
Removes certain immune cells, treats them with light to change their behavior, then returns them. This helps regulate your immune system.
Used for: Skin lymphoma (CTCL), graft-versus-host disease.
Removes excess LDL ("bad") cholesterol from your blood when medications alone aren't sufficient.
Used for: Familial hypercholesterolemia (genetic high cholesterol).
Your doctor may recommend apheresis for several reasons. Here are the most common:
Some conditions require rapid removal of harmful substances that medications cannot address quickly enough. Apheresis can reduce harmful antibodies or toxins within hours — often providing noticeable improvement after just 1–2 sessions.
When standard medications (steroids, immunosuppressants) haven't controlled your condition, apheresis provides an alternative or complementary approach by physically removing the disease-causing substance rather than suppressing it chemically.
Sometimes apheresis is used as a "bridge" — controlling your condition rapidly while longer-acting treatments (like rituximab or immunosuppressants) take effect over weeks or months.
You'll arrive at the apheresis unit — typically a specialized room within a hospital or clinic. A nurse will check your vital signs (blood pressure, pulse, temperature) and review your medications before starting.
Blood needs to flow to and from the machine. Most patients have a temporary catheter (central line) placed in a large neck or chest vein. Some patients use arm veins (peripheral access) for shorter procedures. The nurse will connect you to the apheresis machine.
Blood flows from your body into the machine at a controlled rate. The machine separates your blood components using centrifugal (spinning) force. The target component (plasma, red cells, etc.) is collected, and the rest is returned to your body along with a replacement solution.
You can read, watch TV, use your phone, or sleep. A nurse or technician will check on you regularly and monitor the machine. You may feel a tingling sensation around your mouth or fingers — this is normal and caused by the anticoagulant citrate (which reduces calcium temporarily).
When finished, the catheter is disconnected. Vital signs are rechecked. Most patients feel fine immediately after, though some report mild fatigue. You should be able to leave within 30–60 minutes of the procedure ending.
This varies greatly by condition. Your doctor will explain your specific plan, but here are common patterns:
You will never be alone during a session. A trained nurse or apheresis technician is with you throughout. The machine has multiple safety alarms and automatic shutoffs.
Most patients tolerate apheresis well. Side effects are usually mild and temporary. Your medical team is trained to recognize and manage them quickly.
A tingling sensation around the lips, fingers, or toes. Caused by the citrate anticoagulant, which temporarily lowers blood calcium. Tell your nurse immediately — calcium supplements are given to relieve it within minutes.
Some patients feel tired after procedures, especially during initial daily sessions. This usually improves as your condition responds to treatment. Rest after your session if needed.
Can occur from blood volume shifts. Staying hydrated before the procedure helps. Your team monitors your blood pressure continuously and can slow the machine flow if needed.
The replacement fluid is often room temperature. Blankets are provided. Some machines can warm the returning blood. Dress in layers.
More common when fresh frozen plasma is used as replacement. May cause hives, flushing, or (rarely) anaphylaxis. Pre-medications (antihistamines) are given if you have a history of reactions. Your team monitors for this throughout.
The central line used for access carries a small risk of infection, bruising, or clotting. Your team follows strict sterile protocols. Report any redness, swelling, or pain at the catheter site.
Plasma exchange removes clotting factors along with harmful substances. Extended courses may temporarily affect clotting. Your doctor monitors blood tests and may adjust the procedure accordingly.
When to Contact Your Team: After leaving the unit, contact your medical team if you experience fever, chills, unusual bleeding, severe pain, difficulty breathing, or any symptom that worries you.
Yes. Apheresis does not require sedation or general anesthesia. You will be fully awake throughout. Many patients read, watch television, use their phones, or simply rest. You can speak with your nurse at any time during the procedure.
Most patients report that the procedure itself is not painful. There may be mild discomfort from the needle stick or catheter insertion. During the procedure, you may feel a tingling sensation caused by the anticoagulant — this is not painful and resolves quickly with calcium supplements. Some patients experience mild nausea or lightheadedness, which your team can address.
Yes — in fact, you should eat a light meal before apheresis. Unlike surgery, apheresis does not require fasting. A small snack or light breakfast is recommended. Avoid large, heavy meals immediately before, as some patients experience nausea. Stay well hydrated. Follow any specific instructions given by your medical team.
For your first few procedures, it is recommended to have someone drive you home, as you may feel fatigued or lightheaded. After you know how your body responds to apheresis, you and your doctor can decide whether it is safe for you to drive. Many patients drive themselves to and from routine maintenance procedures once they are established on a treatment plan.
Yes — plasma exchange can remove some medications from your blood along with the substances being targeted. This is particularly important for certain antibiotics, immunosuppressants, and hormonal medications. Always tell your doctor and apheresis team about all medications you take. They may adjust the timing of doses — for example, suggesting you take certain medications after (not before) a session.
Your medical team will monitor your response through blood tests (measuring the levels of the substance being removed) and by tracking your symptoms. Some patients notice improvement after just 1–2 procedures (especially for conditions like myasthenic crisis or TTP). Others take longer. Your doctor will review your progress after each session and adjust the treatment plan accordingly.
They are similar in that both use extracorporeal (outside the body) blood processing, but they are different procedures with different goals. Dialysis removes small waste products (creatinine, urea) from blood in patients with kidney failure. Apheresis removes specific large molecules — such as abnormal antibodies, excess cholesterol, or diseased cells — from blood in patients with a wide variety of conditions. Some patients may receive both therapies simultaneously if they have kidney failure and an additional condition requiring apheresis.
It depends entirely on your condition. For acute conditions like Guillain-Barré syndrome or myasthenic crisis, apheresis is a short course of 5–7 sessions over a few weeks, and then stopped. For chronic conditions like familial hypercholesterolemia or cutaneous T-cell lymphoma, long-term or lifetime maintenance apheresis may be required. Your doctor will discuss the expected duration for your specific condition.
If you have concerns about your treatment, always reach out to your apheresis nurse or physician. No question is too small, and your comfort and understanding are a priority.
Medical Disclaimer: This patient guide is for general educational purposes only and does not replace advice from your own medical team. Every patient's situation is unique. Always follow the specific instructions given by your doctor and apheresis nurses — they know your complete medical history and have tailored your treatment plan specifically for you.