The Therapeutic Apheresis Unit has received professional-institutional accreditation from JACIE-CNS-CNT for its stem cell collection unit within the Transplant Program. The unit is certified compliant with operational standards set by IBMDR, WMDA, and national regulations governing the donation of cells and tissues, as validated by IBMDR, CNS, CNT, CRS, and CRT.
Apheresis is a medical procedure designed to remove harmful substances and/or cells from a patient's blood, which may be reused in subsequent therapeutic programs (e.g., lymphocytes in extracorporeal photochemotherapy or hematopoietic stem cells in autologous or allogeneic transplantation).
Depending on the component removed, apheresis procedures are generically classified into::
· PLASMAPHERESIS: Removal of plasma, also referred to as plasma exchange. The removed component is typically replaced with solutions such as human albumin or fresh frozen plasma.
· SELECTIVE APHERESIS: Removal of specific blood cells, including:
· Plateletpheresis: Removal of platelets.
· Leukapheresis: Removal of white blood cells.
· Erythroapheresis: Removal or replacement of red blood cells.
· Hematopoietic Stem Cell Apheresis: Removal of hematopoietic stem cells.
· Lymphocyte Apheresis: Removal of lymphocytes.
The allogeneic transplantation of hematopoietic stem cells (HPCs) involves the intravenous infusion of HPCs from a donor into a patient who has undergone a preparatory regimen of radio/chemotherapy for immunosuppressive or myeloablative purposes.
The autologous transplantation of HPCs involves the intravenous infusion of HPCs previously collected from the patient and cryopreserved for future use.
Donor hematopoietic stem cells (HPCs) can be collected from:
· Peripheral blood: After the subcutaneous administration of a substance (G-CSF) to the donor, which increases the number of progenitor cells circulating in the bloodstream.
· Posterior iliac crests (pelvic bones): Through bone marrow harvesting under general anesthesia. In this case, it is referred to as a bone marrow transplant.
The Therapeutic Apheresis S.O.U. at Casa Sollievo della Sofferenza is responsible for::
· Recruitment for the Italian Bone Marrow Donor Registry (IBMDR).
· Management of hematopoietic stem cell (HPC) donors (both related and registry donors), from eligibility assessment to follow-up care.
· Mobilization and collection of peripheral HPCs and/or lymphocytes from related and registry donors (approximately 30 procedures per year).
· Collection of autologous peripheral HPCs from patients (approximately 45 procedures per year).
· Extracorporeal photochemotherapy (approximately 50 procedures per year).
· Plasma exchange (approximately 60 procedures per year).
These procedures are conducted using cell separators, advanced devices equipped with computer-controlled programs that isolate and extract specific blood components through centrifugation.
The indications for apheresis therapy are established by the Therapeutic Apheresis Unit physician, in compliance with the guidelines validated by the American Society for Apheresis (ASFA) in 2019 and its subsequent updates and based on recommendations from the specialist responsible for the patient’s clinical care.
The following table lists the most common conditions treated with therapeutic apheresis:
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Medical Specialties
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Conditions
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Available Treatments
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Neurological Disorders
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1. Guillain-Barré Syndrome
2. Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
3. Severe Myasthenic Crisis
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Plasma Exchange
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Hematological Disorders
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1. Thrombotic Thrombocytopenic Purpura (TTP)
2. Hyperviscosity Syndrome associated with Multiple Myeloma
3. Idiopathic Thrombocytopenic Purpura resistant to first-line therapies
4. Acute and Chronic Graft-versus-Host Disease (GvHD) post-transplant
5. Cutaneous Lymphomas (Sézary Syndrome, Mycosis Fungoides)
6. Hyperleukocytosis in Acute Leukemias
7. Essential Thrombocythemia
8. Sickle Cell Disease
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Plasma Exchange
Extracorporeal Photochemotherapy
Depletion Leukapheresis
Depletion Plateletpheresis
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Nephrological Disorders
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1. Goodpasture Syndrome
2. Mixed Cryoglobulinemia
3. ANCA-associated Vasculitis
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Plasma Exchange
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Immunological Disorders
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1. Rheumatoid Arthritis
2. Lupus Nephritis
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Plasma Exchange
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Detoxification Treatments
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1. Poisoning by mushrooms and/or toxic substances
2. Hepatorenal Syndrome
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Plasma Exchange
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U.O.C. Transfusion Medicine
S.O.U. Thalassemia