Shehata et al performed a systematic review to identify all randomized controlled trials involving apheresis published between and Because the diseases treated with apheresis are rare, for many diseases, the published evidence may consist solely of case reports or small case series. Whereas controlled trials may exist for more common diseases, randomized trials are uncommon. To provide practical, evidence-based guidance to the apheresis practitioner and to encourage critical science in the field of apheresis medicine, ASFA has published guidelines on the use of therapeutic apheresis in clinical practice.
The latest guidelines, published in , are the 5th edition. To create these guidelines, a group of apheresis experts reviews the previous guidelines and suggestions from the ASFA membership or interested parties to determine which diseases and disorders should be evaluated. The members are then each assigned specific diseases. They are asked to review the English language literature related to the use of therapeutic apheresis in their assigned disorders.
This is then reviewed by the entire committee, with additional input creating a third draft. After this, based upon consensus of the committee, each disorder is assigned an ASFA category and recommendation grade. The categories are defined in Table 5. The recommendation grade is based upon the Grading of Recommendations Assessment, Development and Evaluation GRADE system 27 and provides the strength of recommendation and an indication of the quality of evidence supporting the use of the apheresis treatment.
A grade 1 recommendation represents a strong recommendation either to perform or not perform the apheresis treatment, depending upon the ASFA category. A grade 2 recommendation represents a weak recommendation. This is further modified by an A, B, or C indicating high-quality evidence, moderate-quality evidence, or low-quality evidence, respectively. The ASFA guidelines are revised and published every 3 years, with the next publication scheduled to occur in June of ASFA categories 2.
The ASFA guidelines have been recognized worldwide and have been translated into Spanish and Russian, with plans for translation into simplified Chinese. Several international apheresis societies have endorsed or adopted these guidelines. Finally, many third-party payers are basing their coverage decisions upon the information included in the guidelines. Plasma exchange is a therapeutic procedure used to treat a wide variety of diseases through the bulk removal of plasma.
Whereas the mechanism of action has been thought to be the removal of pathologic Igs, there is evidence suggesting an immunomodulatory effect. The procedure is safe, with the majority of reactions and complications being mild, easily treated, and of limited duration. Unfortunately, the published evidence supporting the use of plasma exchange is of limited quality. To assist the practitioner in the determining the appropriate use of plasma exchange and other apheresis treatments, and to promote additional studies of the role of apheresis, the ASFA has created evidence-based guidelines that have been accepted internationally as indications for the use of apheresis in clinical medicine.
Off-label drug use: None disclosed. Sign In or Create an Account. Sign In. Skip Nav Destination Content Menu. Close Abstract. Mechanism of action of plasma exchange. Mechanism of plasma removal. Complications of TPE. The American Society of Apheresis clinical guidelines. Article Navigation. Plasma exchange: concepts, mechanisms, and an overview of the American Society for Apheresis guidelines Jeffrey L.
Winters Jeffrey L. This Site. Google Scholar. Cite Icon Cite. Table 1. View large. LDL indicates low-density lipoprotein. View Large. Table 2. Table 3. On Twitter, he is precordialthump. This site uses Akismet to reduce spam. Learn how your comment data is processed. Critical Care Compendium. Chris Nickson. His one great achievement is being the father of two amazing children.
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Plasmapheresis PP or plasma exchange PE :. CPT codes covered if selection criteria are met :. ICD codes covered if selection criteria are met :. Hypergammaglobulinemia, unspecified [Paraproteinemic demyelinating neuropathies associated with IgA, IgG]. Pure hypercholesterolemia [in persons refractory to diet and maximum drug therapy]. Acute disseminated encephalitis and encephalomyelitis ADEM [where conventional treatment has failed]. Other encephalitis and encephalomyelitis [Noninfectious acute disseminated encephalomyelitis noninfectious ADEM ].
Other myelitis transverse [ who fail to improve after corticosteroid treatment]. Multiple sclerosis [acute, severe neurological deficits with poor response to treatment with high-dose glucocorticoids] [not covered for chronic or secondary progressive multiple sclerosis maintenance therapy ].
Acute transverse myelitis in demyelinating disease of central nervous system [who fail to improve after corticosteroid treatment]. Guillian-Barre syndrome [covered for severe, grades Guillain-Barre syndrome - not covered for Miller Fisher syndrome]. Chronic inflammatory demyelinating polyneuritis [CIDP with severe or life threatening symptoms , in persons who have failed to respond ].
Myasthenia gravis [acute with sudden worsening of symptoms][needs rapid improvement of strength before surgery or irradiation] [intermittent treatment for failure to respond to all other treatments] [neuropathy associated with immunoglobulin M gammopathy].
Arteritis, unspecified [anti-neutrophil cytoplasmic antibody-associated vasculitis unresponsive to conventional therapy]. Chronic passive congestion of liver [pruritis from cholestatic liver disease]. Other specified diseases of liver [pruritis from cholestatic liver disease].
Rheumatoid arthritis [moderate to severe active in adults with longstanding who have failed or are intolerant of diseases-modifying anti-rheumatic drugs DMARDs ]. Systemic lupus erythematosus [life threatening, last resort when conventional therapy has failed]. Acute glomerulonephritis, nephrotic syndrome, chronic glomerulonephritis, and nephritis and nephropathy, not specified as acute or chronic [associated with antiglomerular basement membrane antibodies and advancing renal failure or pulmonary hemorrhage].
Other complication of kidney transplant [recurrent focal segmental glomerulosclerosis after renal transplantation]. Other demyelinating diseases of central nervous system [anti-MAG neuropathy]. A01, G A11, G B01, G Nerve disorders, nerve root and plexus disorders, mononeuritis, neuropathy, and myoneural disorders except Refsum's disease, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuritis, and myasthenia gravis [neuropathy associated with immunoglobulin M gammopathy] [idiopathic progressive polyneuropathy] [anti-MAG neuropathy].
Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis [in kidney allograft].
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