Leukapheresis
Leukapheresis is a medical procedure in which white blood cells are removed from a sample of blood. This may be done to decrease a very high white blood cell count in individuals with cancer (leukemia) or to remove white blood cells for transfusion. Alternatively, only granulocytes, macrophages and monocytes can be removed, leaving the lymphocyte count largely unchanged. This is used as a treatment for autoimmune diseases such as ulcerative colitis and rheumatoid arthritis, where these cells play an active part in the inflammation process.
Leukapheresis is recommended as a standard therapy 1:
- Acute myeloid leukemia (AML) with white blood cell > 100,000
- Acute lymphoblastic leukaemia (ALL) with white blood cell > 400,000
In the case of cancer, usually hematological malignancies such as acute leukemias, there are white blood cell counts high enough to cause hemostasis and “sludging” in the capillaries. This very high numbers of leukemia cells in the blood can cause problems with normal circulation, which can lead to heart failure and breathing problems. Chemotherapy may not lower the number of leukemia cells until a few days after the first dose. Because of this time delay, leukapheresis may be used right away − before chemotherapy. In leukapheresis procedure, your blood is passed through a special machine that takes out the white blood cells (including leukemia cells) and returns the rest of the blood cells and plasma back into your bloodstream.
For leukapheresis procedure, you can lie in bed or sit in a reclining chair for a few hours. Two intravenous (IV) lines are needed − the blood is removed through one IV, and then returned to your body through the other IV. Sometimes, a single large catheter is put in near the neck or under the collar bone for the pheresis − instead of using IV lines in the arms. This type of catheter is called a central line and has both IVs built into it.
Leukapheresis is not painful, but sometimes calcium levels can drop during the process. This can cause numbness and tingling (especially in the hands and feet and around the mouth) and, rarely, muscle spasms. This can be treated easily with calcium.
Leukapheresis works quickly to get the number of leukemia cells down. Still, without more treatment (like chemotherapy , monoclonal antibodies , or targeted therapy ) to kill the cancer cells, the cell count will go back up again over time.
Leukapheresis procedure
There is no special preparation for leukapheresis. It is often done urgently and might happen right away when you get to the hospital.
You lie on a bed or reclining chair, with a tube into a vein in each arm. One tube removes blood and passes it into a machine that takes out white blood cells, including the leukaemia cells. The rest of your blood cells and normal blood fluid (plasma) go back into your body through the tube in your other arm.
Your doctor might use your central line if you have one, instead of putting tubes into veins in both arms.
You are awake while you have your treatment. It takes about 2 to 3 hours.
Leukapheresis is not painful but some people find it uncomfortable to stay sitting or lying down in the same place for a couple of hours.
After leukapheresis
Leukapheresis treatment lowers the number of white blood cells straight away. This only lasts for a short time but it can help until chemotherapy has a chance to work.
You might keep the two drip tubes in, in case you need further leukapheresis treatment.
Leukapheresis side effects
Your blood calcium level might go down. This causes:
- numbness and tingling – especially in your hands, feet and mouth
- painful muscle spasms
Let your treatment team know if you have these side effects. They can give you calcium through a drip to help.
References
