Performed at Duke's North Pavilion

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 called 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 or for research. Patients and donors preparing for stem cell transplant will have their stem cells collected.

How to Prepare

Filgrastim (Neupogen®)
Stem cell donors and patients will be given daily injections of a medication 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 medication, along with side effects.

Two days before:
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.

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 a 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 nurse will monitor the patient and the machine throughout the procedure. An apheresis procedure usually takes between one and six hours. Patients and donors are encouraged to eat during the apheresis. You may also bring books, tapes, and movies with you.

During the procedure, you will be connected 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. If you have a double lumen central venous catheter available, that can be used for the procedure. Otherwise, you will have intravenous (IV) catheters inserted into both arms. There may be some minor discomfort at the needle sites.

When the procedure is finished, you will be disconnected from the machine. If you had IV catheters in your arms, these will be removed and dressings applied.

How often apheresis is done depends on the reason for the procedure. When done to collect blood cells for a treatment such as stem cell transplantation, it may be done daily, for one to five days.

Possible Side Effects

The procedure may cause a number of side effects. Some of the more common ones 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, (everyone commented that this is confusing), 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.
• Leave the bandages on your arms for at least two hours.
• Keep the sites dry and avoid exercise or heavy lifting for the rest of the day.
• Lie down and elevate your legs should you become dizzy.
• If the site begins to bleed, apply pressure with a clean cloth and raise your arm until the bleeding stops.
• If a bruise occurs, apply ice for several minutes at a time for the first 24 hours and occasional warm compresses afterwards until soreness has resolved.
• Contact your doctor, if you develop a fever (101.6°F) or chills following apheresis.
• Should any of the above symptoms not improve using the information given, call your physician for further instructions.

If you have any questions regarding your apheresis procedure, please call your Nurse Clinician’s office at 919-668-1002, Monday - Friday from 8 a.m. to 4:30 p.m.

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