Canterbury DHB

Physiological and Adverse effects of Therapeutic Apheresis

The consequences of therapeutic apheresis encompass a broad range of responses. These responses can vary from mild, expected discomforts of the procedure to more severe and unanticipated reactions. Some of these responses constitute a continuous spectrum of symptoms, wherein events at one end are generally agreed to be expected physiological effects, while those at the other end are classified as adverse or untoward reactions. In the following table, the first four items in each category are considered to be at opposite ends, from least to most intense, of the same physiological spectrum.

All adverse apheresis events are to be recorded on the patient’s apheresis record and their hospital notes.

Physiological effects

These are to be expected in most procedures. They do not require cessation of a procedure or of a course of procedures. They are easily treatable or resolve spontaneously.

• Citrate-induced acral or circumoral paraesthesias.
• Mild to moderate drop in blood pressure and/or change in heart rate. These are regularly observed while patient’s blood is in the apheresis machine and may be accompanied by symptoms of light headedness, dizziness or mild epigastric distress.
• Venepuncture related symptoms, including needle discomfort and/or ecchymosis.
• Chilliness that is readily relieved by warming with blankets.
• Alterations in laboratory parameters, particularly after plasma exchange:
  • 5-20% dilution decrease in haemoglobin/haematocrit.
  • 20-30% decrease in platelet count
  • mild leukocytosis
  • significant, but transient and subclinical abnormalities in coagulation tests.

Adverse effects

These are unanticipated and often require cessation of the procedure.

• Citrate related symptoms, including:
  • nausea/vomiting
  • tetany or seizure
  • cardiac arrhythmia.
• Hypovolaemia/vasovagal reactions with:
  • pallor or diaphoresis
  • nausea/vomiting
  • syncope or seizure
  • bradycardia or tachycardia (<50 or >120)
  • severe hypotension (systolic BP <80).
• Complications of circulatory access, including:
  • severe, nerve damage or palpable haematoma at venepuncture site.
  • untoward consequences of central venous access including local or systemic infection,
  • thrombosis, pneumo- or haemothorax, or haemorrhage.
• Severe chills or rigors.
• Cardiac arrhythmias of any cause.
• Immediate complications resulting from infusion of a blood component, including febrile or haemolytic reactions.
• Instrument malfunction or technical error resulting in haemolysis, air embolus, clot embolus, or clotting and loss of blood in the extracorporeal circuit.
• Anaphylaxis
• Respiratory distress
• Circulatory collapse, cardiac arrest or death deemed probably or possibly attributable to an apheresis procedure, including all such events that occur within 4 hours after a procedure.

Topic Code: 38138