Therapeutic phlebotomy and specialized hemapheresis
نویسندگان
چکیده
The sixth comprehensive, evidence-based analysis of apheresis therapies by the American Society for Apheresis (ASFA) recorded 60 disease conditions as Category I (apheresis as first-line therapy) or Category II (apheresis as second-line or adjuvant therapy) indications for therapeutic apheresis. Among these, 37 (62%) were indications for plasma exchange, consistent with prior surveys that found plasma exchange to be the predominant form of apheresis therapy in North America. Whereas apheresis procedures have been in wide use for decades, many on the basis of accumulated experience, the approval of new therapeutic indications, devices, and drugs is increasingly dependent on the presentation of carefully acquired supportive evidence in randomized controlled trials. This applies to phlebotomy and apheresis therapies as well and ASFA presents its recommendations, and the strength of the evidence that underlies them, according to theG.R.A.D.E. system.Accordingly, this chapter, which reviews therapeutic phlebotomyand specialized apheresis procedures that target, for processing, specific fractions of the plasma or cellular compartment of the blood, emphasizes those procedures that are supported by evidence.
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