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Journal of Intensive Care Medicine, Vol. 20, No. 2, 88-103 (2005)
DOI: 10.1177/0885066604273479
© 2005 SAGE Publications

Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications

Michael L. Linenberger, MD

Seattle Cancer Care Alliance, Seattle, WA; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington.

Thomas H. Price, MD

Puget Sound Blood Center, Seattle, WA; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington.

Apheresis is the process of separating the blood and removing or manipulating a cellular or plasma component for therapeutic benefit. Such procedures may be indicated in the critical care setting as primary or adjunctive therapy for certain hematologic, neurologic, renal, and autoimmune/rheumatologic disorders. In part I of this series, the technical aspects of apheresis were described and the physiologic rationale and clinical considerations were discussed. This review highlights the pathophysiologic basis, specific clinical indications, and treatment parameters for disorders that more commonly require management in the intensive care unit. The choice of plasma or cellular apheresis in these cases is guided by wellaccepted, evidence-based clinical treatment guidelines. For some disorders, such as liver failure, severe sepsis, and multiple-organ dysfunction syndrome, apheresis treatment approaches remain experimental. Ongoing studies are investigating the potential utility of conventional plasma exchange, ex vivo plasma manipulation, and newer technologies for these and other disorders in severely ill patients.

Key Words: apheresis • therapeutic plasma exchange • plateletpheresis • leukapheresis • red cell exchange


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