Therapeutic Apheresis in Children

Fundamentally, apheresis refers to the separation or removal of a blood component. Therapeutic apheresis is the use of this technique to treat or manage pathophysiologic disease states. Apheresis can be used to selectively target removal of plasma (plasmapheresis), red blood cells (erythrocytapheresis), platelets (platletpheresis), and leukocytes (leukapheresis). Additionally, the therapy has evolved and it now allows activating leukocytes (photopheresis) and specifically targeting certain proteins (immunoadsorptoin and LDL-apheresis). Although apheresis has been trialed in a wide variety of disease states, the existing data only supports its use in a subset of those conditions and it is important to make evidence based decisions. In this chapter we review the principles of apheresis, describe the therapies offered, and highlight some of the more common indications. Additionally, we describe the manner in which apheresis must be modified for use in children and place the therapy in the context of pediatric medicine.