From the Guidelines
Thrombapheresis is indicated for the treatment of thrombocytosis, a condition characterized by an abnormally high platelet count. The primary goal of thrombapheresis is to rapidly reduce platelet counts in patients who are at high risk for thrombotic complications or who are experiencing active thrombosis. Some key indications for thrombapheresis include:
- Essential thrombocythemia
- Polycythemia vera with elevated platelet counts
- Reactive thrombocytosis causing symptoms or complications Thrombapheresis should be considered when there is an urgent need to rapidly reduce platelet counts, particularly in patients with neurological symptoms, severe headaches, visual disturbances, or evidence of arterial or venous thrombosis, as seen in studies such as 1. The procedure involves removing blood from the patient, separating and removing excess platelets, and returning the remaining blood components back to the patient. This mechanical reduction of platelets provides immediate relief while longer-acting cytoreductive medications begin to take effect. However, thrombapheresis is generally a temporary measure until definitive treatment addresses the underlying cause of thrombocytosis, as the effect is transient with platelet counts often rebounding within days after the procedure, highlighting the need for careful patient selection and monitoring, as noted in guidelines from reputable organizations 1.
From the Research
Indications of Thrombocytapheresis
Thrombocytapheresis is a procedure used to reduce platelet count in patients with essential thrombocythemia. The indications for thrombocytapheresis include:
- High platelet count, typically above 1500 × 10(9)/L, which increases the risk of thrombosis and bleeding 2, 3
- History of thrombosis or bleeding complications 4, 2
- Presence of cardiovascular risk factors, such as hypertension, diabetes mellitus, hyperlipidemias, and tobacco use 4
- Need for urgent surgery, such as coronary artery bypass grafting, in patients with essential thrombocythemia 5
- Failure or intolerance to cytoreductive therapy, such as hydroxyurea or interferon-alpha 2, 3
Clinical Scenarios
Thrombocytapheresis may be considered in the following clinical scenarios:
- Patients with essential thrombocythemia who require urgent surgery and have a high platelet count 5
- Patients with a history of thrombosis or bleeding complications and a high platelet count 4, 2
- Patients with cardiovascular risk factors and a high platelet count 4
- Patients who are resistant or intolerant to cytoreductive therapy 2, 3
Benefits and Risks
Thrombocytapheresis can rapidly reduce platelet count and relieve symptoms in patients with essential thrombocythemia 5. However, the procedure may also have risks, such as a drop and rise in platelet counts postoperatively 5. The decision to use thrombocytapheresis should be made on a case-by-case basis, taking into account the individual patient's risk factors and clinical scenario 4, 2, 3, 5.