TRANSFUSION MEDICINE AND THERAPEUTIC PATHOLOGY

Apheresis Unit

Apheresis and Infusion Services

With its newly expanded space on 3 White, the Apheresis/ Infusion Unit is set to perform blood-collection services, as well as over 10,000 procedures per year on both inpatients and outpatients who suffer from a wide variety of disorders, such as hematologic, coagulation, immunologic, oncologic, neurologic, and genetic disorders, including leukemia and lymphoma, multiple myeloma, rheumatoid arthritis, elevated cholesterol, anemia, thalassemia, sickle cell disease, multiple sclerosis, and myasthenia gravis.
 

Description

Through the use of sophisticated apheresis machines, the transfusion specialists separate patient blood into its cellular and liquid fractions and, depending on the particular disease process, cleanse an individual's blood of either harmful cellular material or soluble plasma factors. For example, by removing plasma ("plasmapheresis") the Apheresis Unit treats a large number of antibody-mediated autoimmune diseases such as myasthenia gravis (a neurological disorder), Goodpasture's syndrome (a kidney disorder), and TTP/HUS (a clotting disorder often associated with viral infection or the ingestion of bacterially contaminated food).

Other procedures include removing elevated levels of white cells ("leukapheresis") to prevent the neurological and pulmonary damage resulting from impeded blood flow that can be experienced by newly diagnosed leukemic patients (hyperleukocytic syndrome) or removing and exchanging red blood cells for fresh banked cells ("erythrocytapheresis") to prevent or treat the pain and morbidity experienced by patients undergoing sickle cell crises.

The Unit also combines apheresis technology with specialized adsorption columns to selectively remove specific disease-causing substances from an individual's circulation. For example, “liposorption” refers to the specific removal of LDL-cholesterol from the plasma of those afflicted with chronically elevated cholesterol levels unresponsive to lipid-lowering medications.

One of the most exciting applications of new apheresis technologies at Penn is for the collection of peripheral blood stem cells that are subsequently used for autologous or allogeneic bone marrow transplantation for the treatment of a number of hematologic malignancies. Another application is the collection of mononuclear cells for the manufacturing of chimeric antigen receptor-modified T cells (CAR-T cells) for the treatment of leukemia and several solid tumor cancers and for the manufacture of dendritic cell vaccines for breast, ovarian, and brain cancers.

In addition to apheresis procedures, the unit is also responsible for the collection of patient red cells for use during or after surgery ("autologous blood"); performing therapeutic phlebotomies on patients with dangerously high red cell counts (polycythemia) or iron levels (hemachromatosis); outpatient transfusions of red cells, platelets, or plasma; and infusions of both natural and recombinant drugs for the treatment of immunodeficiency and autoimmune diseases (e.g. intravenous gamma globulin; cyclophosphamide), infectious diseases (e.g. hepatitis B immune globulin), genetic diseases (e.g. Cerezyme® for Gaucher's disease), and monoclonal antibodies to neutralize toxic mediators of disease (e.g. Remicade® for Crohn's disease and rheumatoid arthritis).

The Apheresis unit is accredited by the AABB, CAP, and FACT.

Faculty and Staff

The Apheresis/Infusion Unit at Penn Medicine is under the medical direction of Drs. Don L. Siegel, MD, PhD, (Director), Una O'Doherty, MD, PhD, Taku Kambayashi, MD, PhD, and Nicole Aqui, MD. Leah L. Irwin, RN, MSN, CRNP, is the Nurse Manager for Apheresis, Infusion and Donor Services.

Twelve additional nurses with specialized training in apheresis, phlebotomy, and infusion therapy; and transfusion medicine residents and fellows (house officers) are also present to provide care for all patients. Procedures involving the ex vivo processing of patient cellular material such as peripheral blood stem cells are performed in our cell processing facility under the supervision of Mary Sell, MT(ASCP) and four other medical technologists.