What Is Leukapheresis?

Leukapheresis is a lab procedure in which white blood cells (also known as leukocytes) are separated from your blood. It is a form of apheresis in which specific components of blood, such as red blood cells or platelets, are extracted while the remaining blood is returned to circulation.

Leukapheresis can be used to reduce an excessively high white blood cell (WBC) count caused by diseases like leukemia. It can also be used to harvest white blood cells that can later be returned to someone whose WBC has dropped due to chemotherapy.

Leukapheresis is also part of a newer form of immunotherapy used to help fight leukemia, 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.

Purpose of Leukapheresis

White blood cells are an important part of the immune 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)

Leukapheresis may be used to decrease an excessively high WBC count caused by certain types of leukemia, most commonly chronic lymphocytic leukemia (CLL) but also acute myeloid leukemia (AML) and chronic myeloid leukemia (CML), A high WBC count is referred to as leukocytosis.

On rare occasions, CLL leukocytosis can lead to a medical emergency known as leukostasis in which white blood cells clump together and block blood flow. Symptoms of leukostasis include shortness of breath, rapid heartbeat, hypoxia (low blood oxygen), and, in extreme cases, coma.

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 called T-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:

• Yescarta (axicabtagene ciloleucel): Used to treat certain types of lymphoma
• Kymriah (tisagenlecleucel): Used to treat acute lymphoblastic leukemia (ALL)
• Provenge (sipuleucel-T): Used to treat metastatic prostate cancer

Granulocytopenia

Leukapheresis may be used on rare occasions to treat people with severe granulocytopenia. Granulocytopenia is abnormally low levels of a type of white blood cells called granulocytes, which includes neutrophils, eosinophils, and basophils.

Granulocytopenia can be the result of a systemic (whole-body) infection, inherited genetic disorders, certain drugs, or autoimmune diseases like lupus or rheumatoid 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 of graft-versus-host-disease in which the donor's cells attack the recipient's tissues.

Granulocyte transfusions are considered controversial and are only used as a last resort.

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:

• Hypocalcemia: This is an abnormal drop in calcium in the blood. Calcium helps regulate nerve function, muscle contractions, and heartbeats. Symptoms include muscle spasms, numbness, irregular heartbeat, and tingling in the hands and feet.
• Anemia: This is the abnormal drop in red blood cells that transport oxygen throughout the body. Symptoms include fatigue, pale skin, irregular heartbeat, dizziness, and shortness of breath.
• Thrombocytopenia: This is a lack of platelets that help blood clot. Symptoms include easy bruising and bleeding, nosebleeds, and blood in the urine or stool.
• Local or systemic infections: This typically occurs in people who are immunocompromised, such as those with advanced HIV infection. Preventive antibiotics (or other antimicrobials) may be needed to treat or prevent infections.

What to Expect with Leukapheresis

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. Some comprehensive cancer centers include them as part of their in-office services.

Apheresis costs between $1,500 and $3,000, depending on where you live. If indicated for the treatment of CLL, leukapheresis will generally be covered (at least in part) by insurance.

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 temporary central venous catheter may 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, an ABO blood typing is needed to ensure that you are a match for the recipient. You will also be screened for infectious diseases including HIV and hepatitis C several 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

Leukapheresis generally takes between one to three hours to perform depending on the type of machine used. It can be performed by a blood specialist known as a hematologist or a qualified medical technologist, nurse, or physician certified in apheresis.

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 a complete blood count (CBC) and a blood 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 is continuous, an IV line is placed in each arm to allow the continuous flow of blood in and out of the body. If the machine is intermittent, 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:

1. The puncture site on your arm will be cleaned with an antiseptic swab. If a catheter is used, the line will be flushed with saline.
2. To reduce discomfort, a local anesthetic may be offered to numb the puncture site.
3. One or more IV lines are placed into your arm(s) and connected to the machine. People with catheters are connected via a special attachment.
4. To ensure that blood doesn't clot and clog the lines, an anticoagulant (blood thinner) like heparin is injected into the IV or catheter line.
5. The machine is turned on. As the blood is extracted and delivered to a collection chamber, it is spun at high speeds (900 to 1,300 rotations per minute) to separate the white blood cells from the rest of the blood.
6. Once separated, the white blood cells are transferred to a sterilized chamber. The remaining blood is pumped back into your body.
7. After enough white blood cells are collected, the machine will be turned off and the IV/catheter lines are disconnected.
8. The IV needle is removed, and the puncture site is covered with gauze and an adhesive bandage. The catheter is cleaned and secured to the chest with an adhesive dressing.

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 other nonsteroidal 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.

Follow-Up

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 a procedure in which white blood cells are separated from the rest of your blood for medical reasons. It can be used to reduce high white blood cells caused by things like chronic lymphocytic leukemia (CLL). It can also be used to harvest and bank cells before chemotherapy in the event the person's white blood cells drop.

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.