Treatment to remove white blood cells (leukapheresis)

Leukapheresis is a way of filtering the blood to remove white blood cells when there are too many. This includes normal white blood cells and leukaemia cells. Other names for this are cytoreductive apheresis or apheresis. 

You might have this treatment if you have a very high white blood cell count that may be causing symptoms. Some of the symptoms might include:

• shortness of breath

• headaches

• tiredness and feeling weak

• changes to your vision

• dizziness

• confusion

• bleeding

Very high numbers of leukaemia cells in the blood can cause problems with normal circulation. You need to have your blood cell count lowered quickly if this happens.

Chemotherapy can lower the number of leukaemia cells in the blood but it takes a few days to work. You might have leukapheresis in the meantime.

Before your leukapheresis treatment

There is no special preparation for leukapheresis.

It is often done urgently and might happen right away when you get to the hospital.

A doctor or nurse will explain what is going to happen. This is usually an apheresis nurse. They will ask you to sign a consent form to confirm you understand the procedure and the possible side effects.

What happens?

The nurse will ask you to get comfortable. It’s a good idea to go to the toilet before this starts as they are unable to disconnect and reconnect you while its running. You can use a commode during treatment if you need to. The staff will do all they can to maintain your privacy.

You sit or lie next to a large machine known as a cell separator. The nurse uses this to remove the white blood cells.

You are awake while you are having this treatment. It can take about 2 to 3 hours. It is good if you can have some things to do to keep you occupied while you have it.

To be able to remove the white blood cells the nurse puts a small plastic tube (cannula) into a vein in each arm. Each cannula has a drip attached.

One tube removes blood and passes it into a machine that takes out white blood cells. The rest of your blood cells and normal blood fluid (plasma) go back into your body through the tube in your other arm.

They might use your central line if you have one. So you would only have one cannula in place as well as your central line.

Before the nurse starts, they take some measurements from you. This includes your:

• height

• weight

• blood pressure

• heart rate

• percentage of oxygen in your blood (saturation level)

• breathing rate

• temperature

The nurse operating the machine stays with you during the procedure and for a little time after. They take regular measurements throughout the procedure.

Leukapheresis is not painful. But some people find it uncomfortable to stay sitting or lying down in the same place for a couple of hours.

You are able to eat and drink normally while it happens.

After leukapheresis treatment

After the procedure you have a blood sample taken. This is to check the number of blood cells and other substances in your blood. You may need some things replacing. For example, you might have a blood transfusion if you have a low levels of red blood cells.

The treatment lowers the number of white blood cells straight away. This only lasts for a short time but it can help until chemotherapy has a chance to work.

You might keep the two cannulas in place in case you need further leukapheresis treatment. Most people only need one treatment, but some might have a 2nd or 3rd.

Side effects of leukapheresis

Leukapheresis can cause side effects. We haven't listed them all. It is very unlikely that you will get all of these side effects, but you might have some of them. How often and how severe the side effects are can vary from person to person.

You are looked after very closely while having leukapheresis. So do tell your nurse if you have any symptoms.

Low levels of calcium in the blood

Symptoms of low calcium levels include:

• numbness and tingling - especially in your hands, feet and around your mouth

• painful muscle spasms

• feeling or being sick

• low blood pressure

Your nurse may give you calcium through a drip or they might give you supplements to take to help relieve these symptoms.

Fainting or feeling faint

Your blood pressure and heart rate might drop suddenly making you pass out. You may go pale, sweat, feel sick, feel agitated or anxious.

You might have some extra fluid through a drip. Your nurse will try to work out a cause for the problem. A possible cause could be you have a low amount of blood circulating throughout your body making you feel this way. This may mean you need a blood transfusion.

Low blood pressure

A low blood pressure can make you feel lightheaded or dizzy. Other symptoms might include feeling sick, blurred vision, feeling weak or confused.

Your blood pressure might also drop when standing up after the treatment. Take extra care when standing up quickly.

Your nurse checks your blood pressure regularly.

Allergic reaction

A reaction may happen during the treatment. This could cause a skin rash, itching, breathing difficulties, fever and chills or swelling of the lips, face or throat.

Tell your nurse immediately if at any time you feel unwell. They can give you medicine to help relieve the reaction.