Performed at Duke Children's Hospital and Health Center

What is Apheresis?

Apheresis is a procedure to withdraw blood from a person and separate it to remove a specific type of cell. This is done with a machine known as a cell separator.

This procedure is used to treat a variety of diseases. It can also be used to collect certain blood products for treating patients and for research studies. Patients and donors preparing for stem cell transplant will have their stem cells collected.

How to Prepare

Filgrastim (Neupogen®)
If you are donating stem cells or white cells, you will be given daily injections of a medicine called Neupogen® which is a medicine to increase the number of stem cells in the blood stream. You will be given specific instructions about starting and stopping this medicine, along with side effects.

Two days before:
Two days before your appointment, eat or drink calcium products such as milk cheese, ice cream, yogurt, or a calcium supplement. Calcium is lost during the procedure so it will help you to have extra calcium in your body. Pediatric patients usually have an IV to give extra calcium during the procedure.

The morning of:
Patients and donors are encouraged to eat during the apheresis procedure. However, avoid drinking large amounts of fluids in the couple hours before the procedure because you will not be able to get up to go to the bathroom. Wear comfortable clothes and shirt or blouse that buttons up the front.

Just before:
A visit to the bathroom just before starting the procedure is encouraged.

What to Expect

Apheresis will be performed as outpatient and you will sit in a reclining chair or a bed. A specially trained medical technician will monitor the machine throughout the procedure and a registered nurse will monitor your vital signs. An apheresis procedure usually takes one to four hours. You may also bring books, tapes, and movies with you. If the donor is a pediatric patient, one parent or caregiver is required to stay with the patient during the procedure.

During the procedure, you will be connected through your apheresis catheter to the cell separator machine by two tubes. One will carry your whole blood to the machine, where the specific cell type will be removed. The second tube will return the remaining blood to you. When the procedure is finished, you will be disconnected from the machine.

How often apheresis is done depends on the reason for the procedure. If it is being done to collect blood cells for a treatment such as stem cell transplantation, it may be done daily for one to five days. If it is being done to collect granulocytes or white cells for a relative, it will be done two days a week for several weeks or longer.

Possible Side Effects

The procedure may cause a number of side effects. Some of the more common side effects you may experience during the procedure are: tingling of the lips, hand or feet, bruising and swelling at the needle sites, fatigue, and lightheadedness.

Some less common side effects are: nausea, vomiting, diarrhea, headache, loss of red cells, rapid or slow pulse, and puffiness. Whenever the skin is broken, there is a possibility of infection. This could occur at the needle site and would be recognized by redness and tenderness at the needle site and fever. Tell your nurse should you experience any of the above symptoms. However, once the procedure begins, there is usually minimal discomfort.

The Neupogen® injections can cause bone pain. Contact your nurse clinician if your pain is not relieved by acetaminophen (Tylenol®).

After Procedure Instructions

You will need to rest, drink extra fluids (non-alcoholic), and eat well.

• Contact your doctor, if you develop a fever (101°F or higher) or chills following apheresis.
• Should any of the above symptoms not improve using the information given, call your doctor for further instructions.
• If you have an apheresis catheter, continue to follow the instructions given to you by your nurse clinician.

If you have any questions regarding your apheresis procedure, please call your nurse clinician’s office at 919-668-1100, Monday-Friday from 8 a.m to 4:30pm.

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your healthcare team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

Source: Cancer Patient Education Program, approved: Duke PEC