Name of the Procedure:

Therapeutic Apheresis; White Blood Cell Removal (Leukapheresis)

Summary

Therapeutic apheresis for white blood cells, also known as leukapheresis, is a procedure that removes excess or abnormal white blood cells from the bloodstream. This is typically done using a specialized machine that filters the blood.

Purpose

Leukapheresis is used to address medical conditions involving high white blood cell counts, such as certain leukemias or severe infections. The goal is to reduce the number of white blood cells to alleviate symptoms and prevent complications such as organ damage.

Indications

Leukapheresis is indicated for patients with:

• Acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) with very high white blood cell counts.
• Hyperleukocytosis, causing symptoms such as breathing difficulties, vision problems, or neurological issues.
• Severe infections or other conditions that require immediate reduction of white blood cells.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Regular medications may need adjustment, and some might be temporarily halted.
• Blood tests are typically performed prior to assess overall health and blood cell counts.

Procedure Description

1. The patient is connected to an apheresis machine via intravenous (IV) lines.
2. Blood is drawn from the patient into the machine.
3. The machine separates white blood cells from the rest of the blood components.
4. The remaining blood (red cells, plasma) is returned to the patient's body.
5. This cycle continues until the desired amount of white blood cells are removed.

The tools and equipment used include IV lines, an apheresis machine, and anticoagulants to prevent blood from clotting. Anesthesia or sedation is not usually required but can be provided if needed for patient comfort.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Leukapheresis is performed in specialized outpatient clinics or hospital settings with access to apheresis machines and trained staff.

Personnel

The procedure involves:

• Apheresis nurses or technicians
• Hematologists or oncologists overseeing the treatment
• Support staff for monitoring patient vitals and comfort

Risks and Complications

Common risks include:

• Fatigue or dizziness due to blood volume changes
• Low calcium levels (hypocalcemia) leading to tingling sensations or muscle cramps Rare but serious risks include:
• Infection at the IV site
• Bleeding or bruising from IV placement
• Changes in blood pressure

Complications are managed by monitoring the patient closely and providing supportive care as needed.

Benefits

The expected benefits include immediate reduction of white blood cell count, resulting in symptom relief and prevention of serious complications. Improvements can often be noticed within hours to days.

Recovery

• Post-procedure, patients may feel tired and should rest for the remainder of the day.
• Follow-up appointments to monitor blood cell counts and overall health are necessary.
• Patients are advised to stay hydrated and avoid strenuous activities for a short period.

Alternatives

Alternative treatments include:

• Chemotherapy, which can also reduce white blood cell counts but might take longer to act.
• Medications that target specific types of white blood cells. The choice depends on the patient's condition, urgency, and overall treatment plan. Each alternative has its own set of advantages and disadvantages.

Patient Experience

During the procedure, the patient may feel some discomfort from the IV lines and a cold sensation as blood cycles through the machine. Post-procedure, they might experience mild fatigue. Pain management, hydration, and rest are recommended for comfort.