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Purpose of Leukapheresis
Possible Risks
What to Expect with Leukapheresis
Leukapheresisis a lab procedure in whichwhite blood cells(also known asleukocytes) are separated from your blood. It is a form ofapheresisin which specific components of blood, such asred blood cellsorplatelets, are extracted while the remaining blood is returned to circulation.
Leukapheresis is also part of a newer form ofimmunotherapyused to help fightleukemia,prostate cancer, and other types of cancer.
This article takes a closer look at the different uses of leukapheresis and what to expect if you or a loved one is scheduled to undergo the procedure.
Verywell / Hilary Allison
White blood cells are an important part of theimmune system. They are made up of different types of cells that help fight infection or disease, Some white blood cells do so directly, while others are responsible for activating or coordinating the immune response. Others have a “memory” and can keep watch for the return of disease-causing organisms.
Leukapheresis can be used to extract all types of white blood cells or just certain types depending on the aims of treatment.
Chronic Lymphocytic Leukemia (CLL)
On rare occasions, CLL leukocytosis can lead to a medical emergency known asleukostasisin which white blood cells clump together and block blood flow. Symptoms of leukostasis includeshortness of breath,rapid heartbeat,hypoxia(low blood oxygen), and, in extreme cases, coma.
Leukapheresis is often used before CLL chemotherapy begins. Because it takes time for chemo to reduce high white blood cells, leukapheresis can give the process a jump start. This helps lower the risk of leukostasis and complications such as heart failure or breathing problems.
What to Know About Autologous Blood Donations
CAR T-Cell Therapy
Chimeric antigen receptor (CAR T-cell) therapy is a newer form of immunotherapy in which harvested white blood cells are altered in the lab to stimulate a specific immune response. CAR T-cell therapy is currently used to help fight certain cancers.
The white blood cells harvested for this procedure are calledT-cells. These are cells tasked with recognizing disease-causing invaders and instigating an immune response.
The harvested T-cells are altered in the lab to create a receptor that is “matched” to a specific type of cancer. When introduced into the body, the altered T-cells recognize the cancer cells and release proteins that help the body’s natural defenses kill them.
The drugs currently used for CAR T-cell therapy include:
In 2024, the FDA issued Safety Labeling Changes for these CAR-T therapies. The warnings inform providers and patients of the potential risk of these therapies causing secondary cancer.
What Is Chemoimmunotherapy?
Granulocytopenia
Leukapheresis may be used on rare occasions to treat people with severegranulocytopenia. Granulocytopenia is abnormally low levels of a type of white blood cells calledgranulocytes, which includesneutrophils,eosinophils, andbasophils.
Granulocytopenia can be the result of a systemic (whole-body) infection, inherited genetic disorders, certain drugs, or autoimmune diseases likelupusorrheumatoid arthritis.
For this procedure, granulocytes are harvested from a donor and irradiated before they are introduced into someone else’s body. This helps reduce the risk ofgraft-versus-host-diseasein which the donor’s cells attack the recipient’s tissues.
Granulocyte transfusions are considered controversial and are only used as a last resort.
How Apheresis Is Used for Stem Cell Transplants
Possible Risks of Leukapheresis
As with all medical procedures, leukapheresis carries certain risks. Most of them are relatively mild. Leukapheresis is generally considered safe and would not be recommended unless there is a medical need.
Even so, it is important to discuss the procedure with your healthcare provider to fully weigh the benefits and risks of treatment.
Among the possible risks of leukapheresis are:
Leukapheresis is a scheduled medical procedure. It involves the use of a specialized apheresis machine that removes blood from your arm under gentle pressure, spins it to remove the intended cells, and returns the blood to your body at the right temperature.
Leukapheresis is typically performed in a hospital or specialized facility equipped with an apheresis machine. Somecomprehensive cancer centersinclude them as part of their in-office services.
Special Preparations
Leukapheresis typically involves the placement of an intravenous (IV) line in your arm.
If a vein cannot be accessed with a regular IV line or multiple leukapheresis procedures are needed, a temporarycentral venous cathetermay be placed in your neck or chest in a separate surgical procedure. This is done in advance of leukapheresis and takes between 45 to 60 minutes to perform.
If you are undergoing leukapheresis for an allogeneic blood donation, anABO blood typingis needed to ensure that you are a match for the recipient. You will also be screened for infectious diseases includingHIVandhepatitis Cseveral days in advance.
Before the Procedure
You will be advised to drink plenty of fluids several days in advance of the procedure. Caffeine should be avoided as it promotes urination and can reduce the relative pressure in your veins.
On the day before the procedure, avoid all caffeinated beverages or foods (including dark chocolate), You can eat a meal beforehand but not one that is large enough to cause discomfort.
Be sure to wear comfortable clothes with short sleeves or sleeves that can be rolled up to allow access to a vein.
On the day of the procedure, bring your insurance card, your driver’s license (or some other form of offer ID), and a method of payment to cover copay costs. You can also bring food and drinks to snack on; they will not affect the procedure in any way.
Finally, plan on bringing someone with you to drive you home as you may feel dizzy or faint after the procedure. Although the staff will not stop you from driving yourself home, they may insist that you rest until you seem reasonably recovered.
During the Procedure
After checking in at the facility, your blood pressure and heart rate will be checked, and you will undergo several tests to ensure that the procedure is safe for you. This includes acomplete blood count (CBC)and ablood calcium test.
Be sure to go to the bathroom before the procedure begins. Once it starts, you will not be able to leave since you will be hooked up to the machine.
Once you’ve been cleared—and your blood pressure, pulse, temperature, respiration rate, and blood tests are all OK—you will be taken to the apheresis room.
Throughout the Procedure
After you are seated next to the apheresis machine, one or more IV lines will be placed in your arm (typically in the antecubital vein in the crook of the arm).
If the apheresis machine iscontinuous,an IV line is placed in each arm to allow the continuous flow of blood in and out of the body. If the machine isintermittent, only one IV line is needed as the blood is removed and returned to the body in phases.
If you were given a central venous catheter, the line will be attached to the machine via two exterior tubes which alternately deliver and return blood to the body.
The procedure itself is relatively straightforward and is similar to what you would have experienced if you ever donated blood:
What Does Leukapheresis Feel Like?You should not feel anything during leukapheresis. If you experience numbness or a tingling sensation, let the nurse know. This is likely due to the anticoagulant drug, the effects of which can be relieved with a calcium supplement.
What Does Leukapheresis Feel Like?
You should not feel anything during leukapheresis. If you experience numbness or a tingling sensation, let the nurse know. This is likely due to the anticoagulant drug, the effects of which can be relieved with a calcium supplement.
After the Procedure
After the procedure is complete, you will be asked to sit for a while to ensure that you are neither faint nor nauseous. Once the nurse is assured that you are OK, you can leave.
It is not uncommon to feel tired after leukapheresis. To get back on your feet faster, limit your activities for the first 12 to 24 hours. If you had an IV line placed in your arm, keep the bandages dry and in place for at least five to six hours before removing them.
If your arm is really sore, you can take an over-the-counter pain reliever like Tylenol (acetaminophen) which is less likely to promote bruising than Advil (ibuprofen) or othernonsteroidal anti-inflammatory drugs (NSAIDs).
If you feel dizzy or lightheaded, lie down and elevate your feet until the feeling passes. It also helps to keep yourself well hydrated.
When to Call Your Healthcare ProviderInfection is rare following leukapheresis but can occur.Call your healthcare provider immediately if you experience worsening pain, swelling, or redness at the injection site as well as fever, chills, or a pus-like discharge.
When to Call Your Healthcare Provider
Infection is rare following leukapheresis but can occur.Call your healthcare provider immediately if you experience worsening pain, swelling, or redness at the injection site as well as fever, chills, or a pus-like discharge.
If leukapheresis is used for an autologous transfusion, the white blood cells will be banked until needed. A preservative solution is typically added to the blood to extend its shelf life.
If the white blood cells are harvested for CAR T-cell therapy, they will undergo procedures to alter their immune function before being returned to the body. (Provenge therapy typically takes three days before the altered cells can be transfused).
Granulocyte transfusions need to be performed within 24 hours of their collection as the cells tend to clump together and become too thick to use after then.
Summary
Leukapheresis is also an integral part of a type of immunotherapy called CAR T-cell therapy, which “trains” harvested cells to help fight certain cancers.
Leukapheresis is generally safe and causes minimal discomfort. The procedure is similar to that of giving a blood donation, with similar risks.
A Word From Verywell
Leukapheresis is an important procedure that can help relieve symptoms and improve the quality of life in people with CLL and other serious medical conditions. What’s more, its use in immunotherapy may one day open the door to creating even more effective targeted cancer therapies.
If leukapheresis is recommended, ask the healthcare provider to walk you through the procedure so that you have a better understanding of what to expect. By asking all of your questions ahead of time, you will likely feel less stressed and be more comfortable on the day of the procedure.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miliotou AN, Papadopoulou LC.CAR T-cell therapy: A new era in cancer immunotherapy.Curr Pharm Biotechnol.2018;19(1):5-18. doi:10.2174/1389201019666180418095526Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF.Leukostasis in adult acute hyperleukocytic leukemia: a clinician’s digest.Hematol Oncol.2016;34(2):69-78. doi:10.1002/hon.2292American Cancer Society.Leukapheresis for chronic lymphocytic leukemia.Ganatra S, Carver JR, Hayek SS, et al.Chimeric antigen receptor T-cell therapy for cancer and heart: JACC Council perspectives.J Am Coll Cardiol.2019;74(25):3153-63. doi:10.1016/j.jacc.2019.10.049Gea-Banacloche J.Granulocyte transfusions: A concise review for practitioners.Cytotherapy. 2017;19(11):1256-69. doi:10.1016/j.jcyt.2017.08.012Philip J, Sarkar RS, Pathak A.Adverse events associated with apheresis procedures: Incidence and relative frequency.Asian J Transfus Sci. 2013;7(1):37-41. doi:10.4103/0973-6247.106730Lisenko K, Pavel P, Bruckner T, et al.Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection.J Clin Apher.2017;32(1):27-34. doi:10.1002/jca.21463American Society for Apheresis.ASFA 2021 reimbursement guide.Schwartz J, Padmanabhan A, Aqui N, et al.Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis.J Clin Apher.2016;31(3):149-62. doi:10.1002/jca.21470Anassi E, Ndefo UA.Sipuleucel-T (Provenge) injection: the first immunotherapy agent (vaccine) for hormone-refractory prostate cancer.P T. 2011;36(4):197-202.American Society for Apheresis.New qualification in apheresis (QIA).Tiwari AK, Pandey P, Subbaraman H, et al.Autologous peripheral blood stem cell harvest: Collection efficiency and factors affecting it.Asian J Transfus Sci. 2016;10(1):93-7. doi:10.4103/0973-6247.164273
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Miliotou AN, Papadopoulou LC.CAR T-cell therapy: A new era in cancer immunotherapy.Curr Pharm Biotechnol.2018;19(1):5-18. doi:10.2174/1389201019666180418095526Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF.Leukostasis in adult acute hyperleukocytic leukemia: a clinician’s digest.Hematol Oncol.2016;34(2):69-78. doi:10.1002/hon.2292American Cancer Society.Leukapheresis for chronic lymphocytic leukemia.Ganatra S, Carver JR, Hayek SS, et al.Chimeric antigen receptor T-cell therapy for cancer and heart: JACC Council perspectives.J Am Coll Cardiol.2019;74(25):3153-63. doi:10.1016/j.jacc.2019.10.049Gea-Banacloche J.Granulocyte transfusions: A concise review for practitioners.Cytotherapy. 2017;19(11):1256-69. doi:10.1016/j.jcyt.2017.08.012Philip J, Sarkar RS, Pathak A.Adverse events associated with apheresis procedures: Incidence and relative frequency.Asian J Transfus Sci. 2013;7(1):37-41. doi:10.4103/0973-6247.106730Lisenko K, Pavel P, Bruckner T, et al.Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection.J Clin Apher.2017;32(1):27-34. doi:10.1002/jca.21463American Society for Apheresis.ASFA 2021 reimbursement guide.Schwartz J, Padmanabhan A, Aqui N, et al.Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis.J Clin Apher.2016;31(3):149-62. doi:10.1002/jca.21470Anassi E, Ndefo UA.Sipuleucel-T (Provenge) injection: the first immunotherapy agent (vaccine) for hormone-refractory prostate cancer.P T. 2011;36(4):197-202.American Society for Apheresis.New qualification in apheresis (QIA).Tiwari AK, Pandey P, Subbaraman H, et al.Autologous peripheral blood stem cell harvest: Collection efficiency and factors affecting it.Asian J Transfus Sci. 2016;10(1):93-7. doi:10.4103/0973-6247.164273
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Miliotou AN, Papadopoulou LC.CAR T-cell therapy: A new era in cancer immunotherapy.Curr Pharm Biotechnol.2018;19(1):5-18. doi:10.2174/1389201019666180418095526Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF.Leukostasis in adult acute hyperleukocytic leukemia: a clinician’s digest.Hematol Oncol.2016;34(2):69-78. doi:10.1002/hon.2292American Cancer Society.Leukapheresis for chronic lymphocytic leukemia.Ganatra S, Carver JR, Hayek SS, et al.Chimeric antigen receptor T-cell therapy for cancer and heart: JACC Council perspectives.J Am Coll Cardiol.2019;74(25):3153-63. doi:10.1016/j.jacc.2019.10.049Gea-Banacloche J.Granulocyte transfusions: A concise review for practitioners.Cytotherapy. 2017;19(11):1256-69. doi:10.1016/j.jcyt.2017.08.012Philip J, Sarkar RS, Pathak A.Adverse events associated with apheresis procedures: Incidence and relative frequency.Asian J Transfus Sci. 2013;7(1):37-41. doi:10.4103/0973-6247.106730Lisenko K, Pavel P, Bruckner T, et al.Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection.J Clin Apher.2017;32(1):27-34. doi:10.1002/jca.21463American Society for Apheresis.ASFA 2021 reimbursement guide.Schwartz J, Padmanabhan A, Aqui N, et al.Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis.J Clin Apher.2016;31(3):149-62. doi:10.1002/jca.21470Anassi E, Ndefo UA.Sipuleucel-T (Provenge) injection: the first immunotherapy agent (vaccine) for hormone-refractory prostate cancer.P T. 2011;36(4):197-202.American Society for Apheresis.New qualification in apheresis (QIA).Tiwari AK, Pandey P, Subbaraman H, et al.Autologous peripheral blood stem cell harvest: Collection efficiency and factors affecting it.Asian J Transfus Sci. 2016;10(1):93-7. doi:10.4103/0973-6247.164273
Miliotou AN, Papadopoulou LC.CAR T-cell therapy: A new era in cancer immunotherapy.Curr Pharm Biotechnol.2018;19(1):5-18. doi:10.2174/1389201019666180418095526
Ali AM, Mirrakhimov AE, Abboud CN, Cashen AF.Leukostasis in adult acute hyperleukocytic leukemia: a clinician’s digest.Hematol Oncol.2016;34(2):69-78. doi:10.1002/hon.2292
American Cancer Society.Leukapheresis for chronic lymphocytic leukemia.
Ganatra S, Carver JR, Hayek SS, et al.Chimeric antigen receptor T-cell therapy for cancer and heart: JACC Council perspectives.J Am Coll Cardiol.2019;74(25):3153-63. doi:10.1016/j.jacc.2019.10.049
Gea-Banacloche J.Granulocyte transfusions: A concise review for practitioners.Cytotherapy. 2017;19(11):1256-69. doi:10.1016/j.jcyt.2017.08.012
Philip J, Sarkar RS, Pathak A.Adverse events associated with apheresis procedures: Incidence and relative frequency.Asian J Transfus Sci. 2013;7(1):37-41. doi:10.4103/0973-6247.106730
Lisenko K, Pavel P, Bruckner T, et al.Comparison between intermittent and continuous spectra optia leukapheresis systems for autologous peripheral blood stem cell collection.J Clin Apher.2017;32(1):27-34. doi:10.1002/jca.21463
American Society for Apheresis.ASFA 2021 reimbursement guide.
Schwartz J, Padmanabhan A, Aqui N, et al.Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the Writing Committee of the American Society for Apheresis.J Clin Apher.2016;31(3):149-62. doi:10.1002/jca.21470
Anassi E, Ndefo UA.Sipuleucel-T (Provenge) injection: the first immunotherapy agent (vaccine) for hormone-refractory prostate cancer.P T. 2011;36(4):197-202.
American Society for Apheresis.New qualification in apheresis (QIA).
Tiwari AK, Pandey P, Subbaraman H, et al.Autologous peripheral blood stem cell harvest: Collection efficiency and factors affecting it.Asian J Transfus Sci. 2016;10(1):93-7. doi:10.4103/0973-6247.164273
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