What Is Apheresis?
Understanding Apheresis in the Context of AL Amyloidosis
Apheresis is a medical procedure that separates specific components of the blood, such as plasma, platelets, white blood cells, or harmful proteins. The remaining blood is returned to the patient’s body. This technique has become an essential tool in modern medicine, especially for managing complex disorders like AL Amyloidosis. For patients and caregivers seeking help on AmyloidosisSupport.in, understanding this procedure can provide clarity and confidence in making treatment decisions.
Apheresis may sound complicated, but its purpose is straightforward: it filters the blood in a highly targeted way. Although AL Amyloidosis itself is a rare and challenging condition, apheresis can help prevent complications, temporarily stabilize the patient, and improve symptoms in certain cases. While it is not the main treatment for amyloidosis, it can serve as an important supportive therapy.
This article offers a detailed guide on what apheresis is, how it works, and why it may be used in AL Amyloidosis, along with benefits, risks, expectations, and recovery insights.
What Is Apheresis?
Apheresis comes from a Greek word that means “to remove.” It is a medical technique that employs specialized machines to separate a patient’s blood into different components. The machine identifies which component is harmful or contributing to disease, removes it, and returns the rest back to the patient.
There are different types of apheresis, such as:
- Plasmapheresis (Plasma Exchange) removes plasma containing harmful proteins.
- Leukapheresis removes white blood cells.
- Plateletpheresis removes excess platelets.
- Erythrocytapheresis removes abnormal red blood cells.
- Immunoadsorption targets and removes specific antibodies or proteins.
In AL Amyloidosis, the most commonly used form is plasmapheresis. It often aims to lower high levels of free light chains, reduce hyperviscosity, or manage complications like neuropathy or organ dysfunction.
How Does Apheresis Work?
The procedure starts with inserting needles into one or two veins. Blood is drawn into the apheresis machine, which uses a spinning centrifuge or a filtering membrane to separate the blood into layers. Each part of your blood has a different density, allowing it to separate naturally when spun.
The machine then:
- Identifies the harmful component
- Removes or replaces it
- Returns the remaining blood back safely to the body
Most of the whole blood is returned immediately to prevent significant blood loss.
A session typically lasts 1.5 to 3 hours, depending on the type of apheresis and the patient’s condition.
Why Is Apheresis Used in AL Amyloidosis?
AL Amyloidosis arises from abnormal plasma cells that produce harmful light chains. These light chains misfold, depositing in organs like the kidneys, heart, liver, and nerves. While apheresis does not stop the production of these light chains (only chemotherapy can do that), it can assist with:
- Rapid reduction of circulating light chains in emergencies
- Management of hyperviscosity due to high protein levels
- Relief of neuropathic symptoms
- Stabilization of kidney or liver function
- Supportive treatment before chemotherapy or transplant
Let’s explore the medical reasoning in more detail.
Reducing Free Light Chains in AL Amyloidosis
The core issue in AL Amyloidosis is excessive free light chains. High levels of these proteins worsen organ damage. Plasmapheresis can temporarily lower these levels.
Though the effect is short-lived, it can be lifesaving in cases where:
- The heart is under severe stress
- Kidney function declines quickly
- Light chain levels reach dangerous highs
- Chemotherapy requires urgent stabilization
For some patients, plasma exchange can reduce short-term risk and enhance readiness for more definitive therapy.
Managing Hyperviscosity Syndrome
Some patients with AL Amyloidosis develop hyperviscosity, a condition that makes the blood thick due to protein overload. Symptoms include:
- Headaches
- Blurred vision
- Nosebleeds
- Dizziness
- Confusion
- Fatigue
In severe instances, it can lead to stroke or heart issues.
Apheresis quickly reduces blood thickness by removing abnormal proteins, providing immediate relief and preventing serious complications.
Improving Neurological Symptoms
Though less common, apheresis can help alleviate:
- Severe neuropathy
- Numbness
- Burning pain
- Tingling sensations
This is more effective when symptoms stem from abnormal antibodies or immune proteins in the blood.
Preparing Patients for Stem Cell Transplant
Autologous stem cell transplant is a key treatment strategy for eligible patients with AL Amyloidosis. Apheresis may be used before the transplant to:
- Reduce free light chains
- Remove harmful proteins
- Enhance safety during the mobilization phase
- Collect stem cells more efficiently (through PBSC apheresis)
Stem cell apheresis itself is a separate process used to gather stem cells from the bloodstream, typically over 1–3 days.
Types of Apheresis Used in AL Amyloidosis
Not all types of apheresis are suitable for AL Amyloidosis. Below are the most relevant options:
Plasmapheresis (Plasma Exchange)
This is the most common and important type for AL Amyloidosis. It removes plasma containing harmful light chains and replaces it with fresh plasma or albumin.
When used:
- High free light chain levels
- Kidney injury
- Heart complications
- Hyperviscosity
- Severe neuropathy
Immunoadsorption
A newer method that uses special filters to precisely remove specific antibodies or proteins.
Benefits:
- More targeted
- Less loss of essential blood components
- Better tolerability for some patients
Leukapheresis
Used when white blood cell counts are extremely high (rare in amyloidosis) but may be applied when amyloidosis is linked to plasma cell leukemia.
What to Expect Before the Procedure
Doctors will assess:
- Blood tests (CBC, kidney function, liver function, calcium)
- Light chain levels
- Coagulation profile
- Heart status
- Blood pressure and hydration levels
You may be asked to:
- Stay hydrated
- Avoid heavy meals
- Inform the medical team about any medications
- Keep your arms warm for easier vein access
Apheresis typically occurs in a day-care or hospital environment.
What Happens During the Procedure
You will sit or lie comfortably while connected to the apheresis machine. Nurses will monitor:
- Blood pressure
- Oxygen levels
- Heart rate
- Temperature
- Flow rate of blood
Most patients feel relaxed and can read, sleep, or listen to music during the session.
You might experience:
- Mild chills
- Tingling around the lips or fingers (due to changes in calcium levels)
- Fatigue
- Temporary pressure at needle insertion sites
These symptoms are normal and usually fade after the procedure.
Post-Procedure Recovery and Care
After the session, patients can generally go home the same day. Doctors recommend:
- Drinking plenty of water
- Eating a balanced meal
- Avoiding strenuous activity for 24 hours
- Monitoring for dizziness
Most patients feel normal within a few hours.
Benefits of Apheresis for AL Amyloidosis
Apheresis offers several advantages, especially in emergencies:
- Rapid reduction of harmful proteins
- Immediate relief of symptoms
- Stabilization of organ function
- Preparation for significant treatments like chemotherapy or transplant
- Improved blood flow in cases of hyperviscosity
- Temporary support for critically ill patients
Though it is not a cure, it can be a powerful supportive therapy.
Limitations of Apheresis in AL Amyloidosis
Apheresis has limitations, including:
- It does not stop the production of light chains
- The effects are temporary (proteins rebuild quickly)
- Multiple sessions are often needed
- It is not effective for all patients
- It can be costly
- Availability varies by hospital resources
Chemotherapy and targeted drugs (like bortezomib, daratumumab) remain the primary treatments.
Risks and Side Effects
Apheresis is generally safe, but possible risks include:
- Drop in blood pressure
- Allergic reactions
- Infection at the needle site
- Bleeding tendencies
- Low calcium levels
- Fatigue or weakness
- Mild fever or chills
Severe complications are rare when performed in expert centers.
Who Should Not Undergo Apheresis?
Apheresis may not be recommended for:
- Patients with severe heart failure
- Extremely low blood pressure
- Uncontrolled bleeding disorders
- Severe infections
- Poor vascular access
Doctors evaluate each patient individually to determine their suitability.
Apheresis vs. Chemotherapy: Understanding the Difference
Many patients confuse apheresis with treatment. The key difference is:
- Apheresis removes harmful proteins temporarily
- Chemotherapy stops the production of abnormal plasma cells (the root cause)
This means apheresis is supportive, while chemotherapy is definitive.
Both may be used together for the best outcomes.
The Role of Apheresis at AmyloidosisSupport.in
AmyloidosisSupport.in aims to educate and empower patients and caregivers by offering:
- Detailed medical insights
- Clear explanations of complex treatments
- Guidance on when procedures like apheresis might be considered
- Emotional support and patient-friendly learning
Understanding procedures like apheresis helps families make informed decisions and supports better communication with healthcare providers.
When Apheresis Becomes Critical
Apheresis may be urgently required when:
- Light chain levels rise quickly
- Sudden kidney failure occurs
- Hyperviscosity symptoms appear
- A patient becomes confused, weak, or short of breath
- Vision problems develop suddenly
- Heart function drops suddenly
Early recognition can prevent serious complications.
Cost and Availability in India
The cost varies based on the hospital, city, and complexity. Average ranges are:
- ₹8,000 to ₹15,000 per session in government hospitals
- ₹15,000 to ₹50,000 in private hospitals
Insurance might cover part of the cost depending on policy terms.
Apheresis is available in major hospitals with hematology and transplant units.
Frequently Asked Questions About Apheresis
Is apheresis painful?
Only the needle insertion causes slight discomfort; the procedure itself is painless.
How many sessions are needed?
It depends on the condition—some need 1–3 sessions, while others may require 5–7.
Does apheresis cure AL Amyloidosis?
No, it supports treatment but does not cure it. Chemotherapy is essential.
Can elderly patients undergo apheresis?
Yes, if their heart and blood pressure are stable.
The Future of Apheresis in Amyloidosis Treatment
Researchers are looking into innovative techniques such as:
- High-efficiency immunoadsorption
- Targeted protein-removal filters
- Personalized apheresis protocols
- Combined therapy with monoclonal antibodies
Future developments aim to make the procedure more targeted and effective.
Final Thoughts
Apheresis is an important supportive therapy for certain situations in AL Amyloidosis. While it cannot replace chemotherapy, it can quickly stabilize patients, lower dangerous protein levels, and improve symptoms. For families dealing with this rare disease, understanding procedures like apheresis builds confidence, reduces fear, and aids in making better treatment decisions.
For more guidance, patient-friendly resources, and AL Amyloidosis information, visit AmyloidosisSupport.in.
