Apheresis Unit (Hematology)

Apherisis is a procedure that makes it possible to separate the various elements of the blood, in particular: 

• the plasma (therapeutic plasmapherisis),
• the red corpuscles (therapeutic erythropheresis),
• the white corpuscles (therapeutic leucapheresis),
• the hematopoietic stem cells (cytapheresis), essential for both analogous transplants (using cells taken from the patient) and allogenic transplants (using the cells of another donor). 

Apheresis is a technique of extraction by centrifugation in an extracorporeal blood circuit (CEC). The components not collected are reinjected into the donor. 

The Apheresis Unit at the Jules Bordet Institute receives, for the ULB-IRIS network as a whole, patients likely to benefit from the collection of stem cells. The Unit works in close cooperation with the various autotransplant centres for adults and with the Children's Hospital (HUDERF). 

We have been practicing apheresis in our service since 1970, with a nursing and technical staff trained especially for the purpose. Two doctors and four nurses are available and ensure the continuity of the medical care, in cooperation with the hematology service as a whole. The Unit has an emergency service that operates 24 hours a day. 

The harvest, handling and conservation of the hematopoietic stem cells is in accordance with good practices. Since 2009 we have been accredited under the inspection programme (JACIE, the "Joint Accreditation Committee of the ISCT and EBMT" ) which makes it possible to improve quality within the various teams involved in carrying out the hematopoietic transplants.  

The Apheresis Unit at the Jules Bordet Institute also gives our patients access to treatment using photopheresis. This treatment is indicated for Graft Versus Host Disease that does not respond to the standard treatment and in certain cases of skin lymphomas. 

Therapeutic apheresis includes, on one hand, plasma exchanges and plasmaphereses and, on the other hand, cytaphereses. 

The therapeutic plasma exchanges eliminate the components of the blood plasma. The plasma is removed from the patient who is then reinjected with red corpuscles and platelets. The plasma exchanges resemble dialysis but can also eliminate toxic substances linked to proteins or proteins produced in excessive quantities.  

In the case of plasmapheresis, a liquid is used as a plasma substitute, whereas in the case of plasma exchange the plasma is replaced by fresh frozen plasma, this permitting a more intense treatment. 

Plasmapheresis has many indications. The frequency of treatment, the volume to be eliminated, the replacement liquid and other variables are decided according to the individual patient. 

Therapeutic cytapheresis eliminates cellular components from the blood and restores the plasma. It can be used to reduce the number of red corpuscles, an excess of platelets or a severe excess of white corpuscles in the case of acute leukemias. 

The principal use of cytapheresis at the Jules Bordet Institute concerns the collecting of peripheral hematopoietic stem cells for an autologous or allogenic reconstitution of the bone marrow (alternative to bone marrow transplant) and the collecting of lymphocytes for the treatment of certain cancers with immunomodulators (immunotherapy). 

The transplanting of hematopoietic stem cells is an intensive and complex treatment that may be proposed to certain patients suffering from a cancer or another hematological disease. A stem cell transplant is today a central strategy for the treatment of leukemias, lymphomas, myelomas and other serious hematological diseases. 

The Cytapheresis Unit is responsible for taking hematopoeitic stem cells from the patient or donor, either from the bone marrow or from the peripheral blood after stimulation. Donating bone marrow has few risks but does require a general anaesthetic. The procedure for collecting peripheral stem cells does not require an anaesthetic and takes three to four hours. Depending on the number of stem cells taken, the procedure can be repeated daily for up to three days to obtain the quantity of stem cells needed for a transplant. The body generally replaces these cells within a few weeks.  

The collection methods are well-defined and structured to ensure the safety of all donors while permitting a hematopoietic graft of high quality. Knowledge of the collection conditions, of the characterisation of the cells collected and of the hematological complaints treated by our collection team permits appropriate care of the hematopoietic donor and host. We carry out more than 200 cell collections a year. 

Our team proposes medical and paramedical training that is specific to apheresis techniques for interns seeking to spend time at the Cytapheresis Unit.